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| Year : 1981 | Volume
: 27
| Issue : 2 | Page : 126-8 |
Intra-osseous lipoma of the calcaneum.
Mohan VV, Gupta SK, Cherian JJ, Lal SS
How to cite this article:
Mohan V V, Gupta S K, Cherian J J, Lal S S. Intra-osseous lipoma of the calcaneum. J Postgrad Med 1981;27:126 |
Intra-osseous lipoma is an extremely uncommon entity despite the large amount of adipose tissue present in the bone marrow. Although, the condition was first described by Wehrsing[7] in 1910, not more than two dozen cases have been reported in the literature. Hence the present case was considered worth recording.
J.K., a forty year old man, police constable by profession, was seen in the orthopaedic services with the chief complaint of pain in the left heel since last 8 months. To start with, the pain was mild in character but the intensity of the pain increased with the passage of time, till it became constant and the patient felt difficulty in attending to his duties.
General physical examination was non-contributory. Local examination revealed tenderness on deep pressure. Laboratory investigations were within normal limits.
With the provisional diagnosis of a calcaneal spur, skiagram of the foot was advised which revealed a well defined well corticated cystic lesion in the left calcaneum [Fig. 1]. There was no evidence of calcification. With the clinico-radiological diagnosis of a benign cyst, curettage of the cyst was done. The histopathology revealed the diagnosis of lipoma [Fig. 2].
Although adipose tissue is a normal and abundant component of the medulla, intra-osseous lipoma of the bone is an extremely rare condition[4], [5] Danlin[2] gave the incidence as 1:1000 of bone tumours.
The commonest location of an intra osseous lipoma is the metaphyseal ends of the long bones.[1] It is interesting to note that out of the 23 reported cases including the present one, 17 have been located at the metaphyseal ends of the long bones and the remaining six in the calcaneum.
There are no specific symptoms of this disease. The common presenting complaints are local pain or swelling or both especially after exertion. These symptoms may be present for months and years. However, the case reported by Poussa and Holstrom[6] was asymptomatic.
The radiological features of this disease are not typical. A well defined cystic lesion within the marrow cavity is the usual appearance. It is significant that in none of the reported cases, was the diagnosis of intra-osseous lipoma possible on radiological findings. The most common roentgen diagnosis in these cases was that of a benign bone cyst.[1] Other conditions considered in the differential diagnosis include fibrous dysplasia, giant cell tumour and other connective tissue tumours.[3] Curettage of the lesion and histopathology have revealed the correct diagnosis in all the reported cases.
The treatment of this rare tumour consists of curettage with or without bone grafting. Recurrence of the tumour is not known.
| 1. | Appenzeller, J. and Weitzner, S.: Intra osseous lipoma of os calcis. Clinical Orthop., 101: 171-175, 1974.  |
| 2. | Dahlin, D. C.: Lipoma and liposarcoma. In, "Bone Tumours." General aspects and data on 3987 cases. Charles C. Thomas, Springfield, Illinosis, 2nd Ed., 1970. |
| 3. | Edeiken, J. and Hodes, P. J.: "Roentgen Diagnosis of Diseases of Bone". Vol. II, The Williams and Wilkins Co. Baltimore, 1973. |
| 4. | Gunterberg, B. and Kindblom, K.: Intra osseous lipoma. Acta, Orthop. Scand., 49: 95-97, 1978. |
| 5. | Muller, M. C. and Robins, J. L.: Intramedullary lipoma of the bone. J. Bone and Joint Surg., 42A: 517-520, 1960. |
| 6. | Poussa, M. and Holmstrom, T.: Intra osseous lipoma of calcaneum. Acta Orthop. Scand., 47: 570-574, 1976. |
| 7. | Wehrsing: Lipoma des knuhenmarks. Z. Allg. Pathol., 21: 242-247, 1910. |
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