J Korean Foot Ankle Soc.  2015 Mar;19(1):27-31. 10.14193/jkfas.2015.19.1.27.

Intraosseous Calcaneal Lipoma with Subtalar Perforation through Cystic Degeneration: A Case Report

• Kumar A
• Stephanie
• Choi JY
• Chang S
• Suh JS

• KMID: 1958702
• DOI: http://doi.org/10.14193/jkfas.2015.19.1.27

Abstract

Intraosseous lipoma is a benign tumor that originates from proliferating mature lipocytes. It often occurs in the metaphysis of long bones of the lower extremity, and also in the calcaneus, humerus, mandible, sacrum, and rib bones. Frequently, it involutes spontaneously through a process of infarction, calcification, and cyst formation. It can either present as pain, or be asymptomatic and only discovered through an incidental radiological finding. In our case, the patient presented with heel pain. Intraoperatively, it was found that the intraosseous cavity was filled with fat along with an adjacent but separate area of cystic degeneration. There was also a cortical perforation at the cystic lesion which was communicating with the subtalar joint. This cortical breach is most likely the cause of diffuse lateral heel pain experienced by our patient, and such a pathological fracture due to intraosseous lipoma has never been reported.

Keyword

Bone neoplasms; Calcaneus; Cortical perforation

MeSH Terms

Adipocytes
Bone Neoplasms
Calcaneus
Fractures, Spontaneous
Heel
Humans
Humerus
Infarction
Lipoma*
Lower Extremity
Mandible
Ribs
Sacrum
Subtalar Joint

Figure

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  Figure 1. Axial radiologic view shows cystic degeneration of calcaneus.

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  Figure 2. Lateral view of calcaneus shows superior and anterior extension of cystic change up to the subtalar joint and calcaneo-cuboid joint respectively.

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  Figure 3. T1-weighted low to intermediate (A) and T2-weighted high mass like lesion on the sagittal (B) and coronal plane (C) are shown in the calcaneus.

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  Figure 4. Intraoperative image shows lesion centered between the two peronei.

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  Figure 5. Flouroscopic image shows perforation of subtalar joint on the joint weighted image-coronal cut.

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  Figure 6. Postoperative radiograph shows cancellous graft and fixation of window using two screws.

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  Figure 7. The trabecular bone is intermixed with the adipocytes and small blood vessels. Hematopoietic elements are absent. These findings are consistent with intraosseous lipoma (H&E stain, x100).

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  Figure 8. Complete consolidation of the lesion (arrows) is shown on the plain radiograph taken at 15 months postoperatively (A) and after screw removal (B).

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