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Thread: HELP: Posteromedial mass of the ankle

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    Question HELP: Posteromedial mass of the ankle

    We're given this ortho case in our school, I need some opinion about this. There's this 27yr old female patient complaining of a firm mass on her left ankle (posteromedial side) noticing it 1 year prior to consult. She ignored it for a while but noticed it to be rapidly enlarging, so she went to the GS service of the Makati Medical Center and the GS ordered for an ultrasound which showed an AV malformation, and was subsequently referred to the vascular surgery unit of the said hospital. 4 months PTC, the vascular surgeon did an fluoroscopic angiography to plan for an endovascular embolization, but the surgeon opted not to do the embolization because of the angiographic findings (no findings given). The vascular surgeon then referred the patient to the orthopedic service of the said institution. The ortho assessed the mass as tender, tense(cystic?), non-pulsatile postero-medial left ankle mass, with no signs of neurovascular compromise. MRI scan showed a soft tissue mass with well defined borders, and a heterogenous tumor matrix. No biopsy report yet.

    We already were able to point out on the mistakes the GS made but I'm left confounded with the most probable clinical impression on this case. I hope you guys could help me on this. Thanks!!!

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    Most likely cause is a Ganglion cyst.
    Differential diagnosis include giant cell tumor of the tendon sheath, a myxoma, a nerve sheath tumor. May also be malignant synovial sarcoma, myxoid chondrosarcoma or metastasis.

    Let us know the biopsy report when it's ready.

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    Sure thing. Thanks by the way, but wouldn't a ganglion cyst be readily seen in an ultrasound as cystic mass and not to be easily mistaken for an AV malformation?

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    USG would have surely picked up an AV malformation (even clinically due to pulsations and auscultation). If MRI shows soft tissue mass, then we go in favour of tumour.

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    thanks man. yeah, that's one of the mistakes made by the GS here, immediately relying only on the ultrasound findings for the diagnosis of the patient's mass. I understand that dx of AV malformation requires color doppler imaging? if so, what they picked up as "high flow" could have just been the neovascularizations of the tumor.

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