Intraosseous Lipoma of the Calcaneum

Abstract

Lipomas are benign lesions of adipose tissue, which commonly affect the soft tissues but are rarely found in the musculoskeletal system. Intraosseous lipomas are rare benign tumors and even rarer in calcaneum, only to be found incidentally in the majority of cases. We report a case of a 45-year-old male patient who presented to the outpatient department with complaints of bilateral heel pain, which was initially treated conservatively as the presentation was similar to plantar fasciitis. On further follow-up, a plain radiograph of the ankles was taken, which showed a lytic lesion of the calcaneum with mild sclerotic margins on the right side with normal left foot radiographs. On magnetic resonance imaging, the lytic lesion demonstrated hyperintense signals on T1-weighted sagittal images, characteristic of fatty tissue, which helped us in arriving at the diagnosis of an intraosseous lipoma. The patient was treated by conservative means with physiotherapy, which relieved the pain, and on serial follow-ups, the lesion was found non-progressive on successive radiological evaluation. The differential diagnosis of such an entity includes plantar fasciitis, tumors such as an aneurysmal bone cyst, bone infarct, etc. With the increasing use of magnetic resonance imaging and computed tomography scans, physicians should be aware of the possibility of an intraosseous lipoma of the calcaneum, which should be ruled out during evaluation. Although possible, malignant pathology or aggressive transformation of such lesions is very rare; however, the lesion should be evaluated adequately and managed by surgical means in cases non-responsive to various conservative modalities.

Intraosseous Lipoma Mimicking Periapical Lesion: A Rare Presentation

“…There is also another theory stating "metaplasia theory" where these occur due to aberrant differentiation of in situ mesenchymal cells into lipoblast because, from mutable cells of connective tissue, adipose tissue can be derived in any part of the body [10,11]. Some authors also concluded that lipoma is benign, congenital arising from multipotential cells of the embryo, and remains inactive subclinically, which under hormonal influence develops into adolescence and differentiates into adipose cells [8,9,11]. In some cases, trauma and chronic irritation fasten the proliferation of soft tissue and develop a lipoma [9][10][11].…”

“…Some authors also concluded that lipoma is benign, congenital arising from multipotential cells of the embryo, and remains inactive subclinically, which under hormonal influence develops into adolescence and differentiates into adipose cells [8,9,11]. In some cases, trauma and chronic irritation fasten the proliferation of soft tissue and develop a lipoma [9][10][11].…”

“…Intraosseous lipomas are not based on radiology alone, and therefore, differential diagnosis is very necessary and conducted for a long time [7,8]. CT scan and Magnetic resonance imaging give a tissue-specific diagnosis [8,9]. If there is a presence of a predominant fatty component in a lesion, it confirms its benign nature, and hence, no further diagnostic procedures are needed [8][9][10].…”

“…CT scan and Magnetic resonance imaging give a tissue-specific diagnosis [8,9]. If there is a presence of a predominant fatty component in a lesion, it confirms its benign nature, and hence, no further diagnostic procedures are needed [8][9][10].…”

“…The nature and etiopathogenesis are not very clear and are unknown [8,9,14,15]. They usually grow asymptomatic and slow, which is why patients do not seek treatment [16].…”