UNASSIGNED: A 25-year-old woman presented with progressive pain and swelling over the right foot for 4 years. On examination, there was a gross swelling over the fourth metatarsal region over the dorsum of the foot. Radiographs revealed a osteoblastic lesion of the fourth metatarsal bone expanding into the intermetatarsal region. Magnetic resonance imaging (MRI) revealed an expansile altered signal intensity lesion which was hypointense on both T1 and T2 - weighted images with no soft-tissue component. With a working diagnosis of locally aggressive bone-forming tumor, she underwent wide excision of the tumor with reconstruction using a non-vascularized fibular autograft. Intraoperative samples sent for histopathological examination confirmed the diagnosis of osteoblastoma. After 2 years of follow-up, the patient is able to weight bear with no pain and imaging shows graft incorporation with no signs of recurrence.
UNASSIGNED: Osteoblastoma of the metatarsal region can present a diagnostic conundrum to the treating clinician due to its rare nature. Proper evaluation and reconstruction at an early stage with wide excision and reconstruction with non-vascularized fibular autograft are a reliable treatment option.
■一名25岁的女性表现为右脚进行性疼痛和肿胀4年。在检查中,脚背的第四跖骨区域有一个严重的肿胀。放射学照片显示第四meta骨的成骨细胞病变扩展到meta骨之间区域。磁共振成像(MRI)显示出扩张性改变的信号强度病变,在T1和T2加权图像上均为低信号,没有软组织成分。通过对局部侵袭性骨形成肿瘤的有效诊断,她使用非血管化腓骨自体移植进行了肿瘤的广泛切除和重建。送去组织病理学检查的术中样本证实了骨母细胞瘤的诊断。经过2年的随访,患者能够承受体重而没有疼痛,影像学显示移植物合并,没有复发迹象。
■由于其罕见性质,跖骨区域的成骨瘤可以给治疗临床医生带来诊断难题。通过广泛切除和非血管化腓骨自体移植重建的早期正确评估和重建是可靠的治疗选择。