Lesion in the Foot at Birth

Abstract

A four-month-old male infant was brought to the outpatient department of our tertiary care hospital with swelling in the right foot, which was noticed since the day of birth. The swelling increased in size and had bled profusely a month earlier, which was managed with compression. On examination, a 7.2 × 7.8 cm, single non-pulsatile, well-defined reddish-purple lobulated mass was noted in the distal half of the right foot, involving the plantar side of the forefoot and mid-foot. There was a healed ulcer on the ventral aspect of the lesion. The third, fourth, and fifth toes were engulfed by the mass. The mass had a variegated consistency, firm in some areas and hard in the rest. Blood investigations including hemoglobin and platelet count yielded normal results. A plain X-ray of the foot suggested a soft tissue swelling with a few subtle radio opacities within the lesion suggestive of phleboliths. Doppler ultrasound revealed multiple arterial channels with high flows and dilated venous channels. Contrast-enhanced magnetic resonance imaging showed a highly vascular mass in the right forefoot encasing the fourth toe, extending to third, fourth, and fifth web spaces and third and fourth metatarsal heads, along with the respective proximal phalanges. Early arterial enhancement was noted. An excisional biopsy in the form of partial forefoot amputation was performed and the wound was covered with a split-thickness skin graft. Histological examination revealed a cellular mass composed of sheets of monomorphic spindle cells. A diagnosis of congenital infantile fibrosarcoma (CIF) was made. After ruling out regional and distant metastasis, a below-knee amputation was done to achieve surgically clear margins. The child was disease-free at the four years follow-up.

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