Calcaneal intraosseous lipoma

Case contributed by Dr Mohamed Hossam el Deen

Presentation

History of chronic Right ankle pain.

Patient Data

Age: 27
Gender: Male
X-ray

Plain radiograph shows a well circumscribed radiolucent  expansile lesion in the center of the calcaneus bone with sclerotic borders.There is no cortical destruction.

CT

CT scan shows intraosseous well defined fat density lesion with sclerotic margins in the central area of calcaneal body. There are areas of high density inside the lesion that may represents hemorrhagic components.

MRI

MRI sagittal view , different sequences show typical fatty appearance of calcaneal lipoma in the form of high signal intensity (SI)  in both T1 and T2 and loss of SI in STIR protocols. The lesions inside the lipoma show different signal patterns with different protocol that represent different stages of intra-lesion hemorrhages or necrosis. By MRI with contrast there is contrast uptake mainly surrounding the hemorrhages/necrosis.

Case Discussion

This is a case of intraosseous lipoma of right calcaneal bone . It is composed of fat cells that replace the resorbed  bone trebeculae. The former my undergoes degenerative process that ends up with cystic spaces and dystrophic calcifications  inside the lipoma.

 

Stages of calcaneal lipoma :

Stage I : The  lesion composed of  lipocytes, similar to the cells of subcutaneous adipose tissue.

Stage II:  Necrotic foci and foci of reactive osteogenesis are present.

Stage III:  Advanced necrotic lesions with focal calcifications and cystic degeneration.

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Case information

rID: 40439
Case created: 21st Oct 2015
Last edited: 13th Jan 2016
Inclusion in quiz mode: Included

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