Case report Open Access Calcaneal osteosarcoma, a challenge for diagnosis: a rare case report and literature review Barada Prasanna Samal 1* , Chandrakant Nayak 1 , Sarita Pradhan 2 , Tapan Kumar Sahoo 3 , Aswini Kumar Jena 4 and Sasmita Pradhan 5 Abstract Osteosarcoma of calcaneum is of rare occurrence. Infrequent occurrence produce dilemma and challenge to it’s diagnosis, leading to a delayed treatment. Here we present a rare case of chondroblastic variety of calcaneal osteosarcoma in an adolescent that produced a dilemma for diagnosis. Here also we have discussed the available literature regarding the clinical, radiological and histological features of calcaneal osteosarcoma. Keywords: Calcaneum, osteosarcoma, chondroblastic type, dilemma in diagnosis, rare occurence © 2015 Samal et al; licensee Herbert Publications Ltd. Tis is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). Tis permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Though osteosarcoma is the 2 nd most common primary ma- lignancy of bone, involvement of foot as a site is rare. Pedal osteosarcoma has an incidence rate of 0.2-2% [1]. Among the tarsals calcaneum is the favoured site [2]. Rarity of occurrence is the main reason behind it’s missed and delayed diagnosis [2,3]. According to some authors osteosarcoma of foot consti- tute a different spectrum of osteosarcoma with slightly more favourable outcome [2,4,5]. The key to long term survival being early diagnosis and management, a high degree of suspicion is needed while evaluating a mass lesion of calcaneum. Here we present a rare variety (chondroblastic) of osteosarcoma of the calcaneum and showed how diagnostic confusion lead to delayed diagnosis of the lesion. Case presentation A 15 year hindu male presented to our outpatient department with complain of pain in the left heel and widened appearance since last 1 year. Pain was insidious onset, slowly progressive, dull aching, none radiating, aggrevated by activity and relieved with rest & analgesics. On examination there was circumferential swelling of the left calcaneum, bony hard in consistency, with an ill defined border & dilated tortuous vein on surface but no scar or sinus. There was no local rise of temperature and progression of growth being accelerated in last 3months (Figures 1 and 2). Patient had a bunch of x-rays and two inconclusive FNAC reports. X-ray showed a dense sclerotic lesion involving the left cal- caneum, with abundant periosteal reaction creating a sunburst appearance and infiltrating the surrounding soft tissue (Figure 3). NCCT with 3D confirms the diffuse periosteal reaction of calcaneum (Figures 4 and 5). MRI showed heterogeneous mass of low intensity involving the entire calcaneum with infiltration and oedema of surrounding soft tissue. NCCT of chest showed no sign of metastasis. Other biochemical test showed no abnormality. Biopsy was taken with lateral incision and tissue sent for histopathology study. Histopathology section showed a malignant tumor infiltrating the bone with exuberant osteoid formation. Individual cell showed moderate cytoplasm, enlarged irregular hyper chromatic to vesicular nuclei with coarse chromatin with prominent nucleoli. Many bizarre nuclei with atypical mitosis were seen. Many areas showed destruction of bone and cartilage. Other areas showed chondroid degeneration (Figure 6). Patient was undergone a below knee amputation and has a no local recurrence at 1 year follow-up. Discussion Osteosarcoma of foot is of rare occurrence. Berlin in his review of 67000 cases of foot tumors reported a malignancy rate of 1% and found that clinical feature of foot osteosarcoma are atypical [6]. *Correspondence: sandlandhero82@gmail.com 1 Department of Orthopaedics, All India Institute of Medical Science, Bhubaneswar, India. 2 Department of Pathology, IMS & SUM Hospital, Bhubaneswar, India. 3 Department of Radiotherapy, All India Institute of Medical science, Bhubaneswar, India. 4 Department Of Orthopaedics, S.C.B Medical College, Cuttack, India. 5 Department Of Community Medicine, S.C.B Medical College, Cuttack, India. Oncology Discovery ISSN 2052-6199 | Volume 3 | Article 2 CrossMark ← Click for updates