A Painful Tibial Mass in a 37-year-old Man

Abstract

A 37-year-old man presented with right leg pain of 4 months' duration. He was athletic and jogged several miles daily. He initially was evaluated and diagnosed with a stress fracture and was told to avoid weightbearing and exercise, but his symptoms did not improve. He had little symptomatic relief with the use of nonsteroidal antiinflammatory medications. Except for a history of ulcerative colitis in remission, his medical history was unremarkable.Physical examination revealed a healthy and athletic appearing man with a 2-cm hard and immobile mass on the anterior aspect of his right upper tibial shaft. The lesion was extremely tender to palpation particularly in the center.The patient, however, showed a full range of motion of his right leg. There were no skin changes. The remainder of the physical examination was unremarkable. He had no fever and his laboratory studies, including white blood count and differential, were normal.Radiographs, computed axial tomography (CT) images, and magnetic resonance imaging (MRI) scans of the right tibia were obtained (Fig.

Intraosseous leiomyoma of the calcaneum: An unusual bone tumor of foot and review of literature

“…The histopathology shows smooth spindle cell stroma and positive immunohistochemistry staining for muscle markers. 1 Intraosseous leiomyoma in axial skeleton involving mandible, temporal bone and ribs and appendicular skeleton involvement of ulna, tibia, proximal femur and distal femur are reported in medical literature [2][3][4][5][6][7][8][9] (Table 1).…”

“…The postulated theory for the origin of this intra-osseous tumor is it originates from the smooth muscle tissue in the vascular system of the bone. [2][3][4][5][6][7][8][9] Intraosseous leiomyoma presents with a painful swelling. There is female preponderance and are seen in skeletally mature individuals.…”

“…Histopathological examination of lieomyoma is having spindle cells with elongated nuclei, eosinophilic cytoplasm arranged in whorled or fasicular pattern. [1][2][3][4][5][6][7][8][9] The benign tumors with similar histological features are nerve sheath tumors, non ossifying fibroma, fibrous histiocytoma. Immunohistochemistry stains are helpful for the diagnosis of these tumors.…”

“…desmin, smooth muscle actin and the markers S100, CD 34 are negative. [1][2][3][4][5][6][7][8][9] Bundles of smooth muscle strongly staining for smooth muscle actin are diagnostic of leiomyoma. The differentiating features between intraosseous leiomyoma and lioemyosarcoma are lack of features of malignant spindle cell tumor, cellular atypia, mitosis and necrosis.…”

“…2 To the best of our knowledge, the only reported intraosseous leiomyomas in extremities occurred in the proximal aspect and distal aspect of the femur, in the tibia, and in the ulna. [3][4][5][6][7][8] We are not aware of any previous reports of intraosseous leiomyomas in the foot. The radiograph of the intraosseous leiomyoma shows unilocular or multilocular lytic lesion with sclerotic rim.…”