Subcutaneous Myoepithelioma of Foot Mimicking as Hemangioma: an Unusual Presentation with Review of Literature
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CASE REPORT
Subcutaneous Myoepithelioma of Foot Mimicking as Hemangioma: an Unusual Presentation with Review of Literature Spoorthy Rekha Y.C. 1
&
Gale Kathleen 1 & Sunil Kumar Alur 2
Received: 30 August 2019 / Accepted: 7 May 2020 # Indian Association of Surgical Oncology 2020
Introduction Myoepithelial tumors of soft tissues are rare tumors of uncertain histogenesis included in the “mixed tumor/parachordoma family” of soft tissue tumors (WHO classification). The spectrum of such tumors includes various terminologies based upon anatomic location, such as pleomorphic adenoma in the salivary gland, benign mixed tumor in the skin, and myoepithelial tumor/ parachordoma in the soft tissues. Cutaneous myoepitheliomas are extremely rare, benign, dermal tumors located mainly in the subcutaneous and sub-fascial planes of the extremities especially in the muscles of the thigh, groin, calf, upper arm, and forearm. They are seen in patients of all ages with a peak incidence in the second and fourth decades of life [1, 2]. Only a few case reports of myoepithelioma, primarily occurring in the dermis have been described, of which < 10 cases have been reported in the foot and ankle literature. We report a case of subcutaneous myoepithelioma arising over the medial malleolus of the foot of a 70-year-old male.
Case Report A 70-year-old male presented to surgical OPD with complaints of swelling over the medial malleolus of the left foot with 2 years duration, gradually increasing in size associated with mild dragging pain. On examination, overlying skin appeared unremarkable with a subcutaneous swelling measuring * Spoorthy Rekha Y.C. [email protected] 1
Department of Histopathology, Elbit Medical Diagnostics Limited, Indian Express Building, 1 & 1/2, Dr Ambedkar Veedhi, Vasanth Nagar, Bengaluru, Karnataka 560001, India
2
Department of Surgery, PD Hinduja Sindhi Hospital, Bengaluru, India
5 × 4 cm with well-defined borders and partial mobility. Initial evaluation done with the Doppler study revealed a vascular heterogeneous lesion with multiple intralesional hypoechoic foci (phleboliths) suggesting a possibility of hemangioma. Further imaging with an MRI study revealed a well-defined space-occupying lesion in the subcutaneous plane of ankle over the medial malleolus. The lesion was seen in close proximity to the tibialis posterior tendon and showed multiple hypointense areas, indicating intralesional hemorrhage. Differentials considered included space-occupying lesions of the ankle—synovial sarcoma, nodular fasciitis, and peripheral nerve sheath tumor. Excisional biopsy with overlying skin was sent for histopathological examination. Gross examination revealed a gray brown nodular soft tissue measuring 4 × 4 × 3 cm with a fragment of the skin (Fig. 1). External surface appeared capsulated and smooth. Cut surface showed hemorrhage with solid gray tan areas and intervening foci of glistening appearance suggesting cartilage with hard bone–like consistency. Hematoxylin and eosin stained sections revealed a capsulated neop
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