Calcaneal chondrosarcoma: a case report

Abstract

The objective was to report on a rare case of chondrosarcoma of the bones of the foot, and specifically the calcaneus. The patient was a 30-year-old woman with a complaint of painless nodulation on the lateral face of the calcaneus, which she had had for around eight years, which then started to present significant pain. Radiography showed a tumor with imprecise limits, compromising the calcaneus, talus and lateral malleolus. The lesion had a destructive, aggressive and osteolytic appearance, with invasion of the surrounding soft tissues and the presence of points of calcification. Amputation was performed in the middle third of the right lower leg, with a histological diagnosis of chondrosarcoma. The case evolved with local recurrence of the tumor formation and subsequent amputation in the middle third of the right thigh. One year after the second amputation, the patient evolved with metastasis from the chondrosarcoma in soft tissues throughout the body and in the lungs, and she died one year and ten months after the diagnosis was made. Chondrosarcomas that involve the calcaneus are rare in young adults, with few reports in the literature. For this reason, the present report becomes important in that it shows that even though this is a rare condition, it is present in our environment. Early investigation is essential, especially by means of imaging examinations, with the aim of diminishing the chances of malignant transformation and consequent complications, so as to avoid death.

Primary tumours of the calcaneus (Review)

“…Chondrosarcoma has an indolent natural history, ranging from 8 months to 36 years ( 102 ). Clinically, chondrosarcoma is characterized by insidious, gradual and progressive pain ( 103 ). Upon physical examination, the swelling is diffuse, mildly tender to palpation, and occasionally accompanied by a local increase in temperature ( 103 , 104 ).…”

“…Macroscopically, the tumour tissue presents with a straw-yellow colour ( 103 ). Microscopy may reveal numerous pleomorphic chondrocytes with hypercellularity and cytologic atypia.…”

“…Wide surgical resection or amputation remains regarded as a mainstay method, while simple curettage or local excision is not recommended due to recurrence ( 102 – 106 ). If the tumour (Enneking stage IIA) is restricted to a bone that may be completely removed with an appropriate amount of soft tissue, a wide excision is recommended and usually requires at least a 5 cm safety margin ( 102 , 103 , 106 , 107 ). For patients with a stage IIB tumour, amputation is recommended and believed to result in an improved disease-free survival rate ( 102 – 107 ).…”

“…For patients with a stage IIB tumour, amputation is recommended and believed to result in an improved disease-free survival rate ( 102 – 107 ). Although chemotherapy and radiotherapy have no effect in chondrosarcoma, they are administered as a palliative therapy in the case (stage III) of metastatic and inoperable disease ( 103 , 105 ).…”

“…Recurrence and metastasis of chondrosarcoma constituted nearly 50% of all patients in one previous study ( 102 ). Metastasis typically occurs to lungs and proximal bones ( 103 – 105 ). Owing to the propensity for recurrence and metastasis, all patients with chondrosarcoma of the calcaneus require long-term follow-up ( 102 – 104 ).…”