Case contributed by Maulik S Patel
Diagnosis certain


A farmer presented with right midfoot plantar region nodule for the last 5 to 6 years. It was associated with mild pain.

Patient Data

Age: 40 years
Gender: Male

There is a nodule in the midfoot plantar region. The overlying skin is showing mild discoloration; however; it remains intact.


There is a conglomerate of hypoechoic nodules which are subcentimeter in size. These hypoechoic nodules show central echogenic focus. There is no cystic changes, calcification or Doppler flow in the lesion. The lesion is located in subcutaneous fat and it abutts plantar fascia. Approximate size of the lesion is 30 x 26 x 14 mm.


Intraoperative and gross specimen photos.


Sections and smears show features are consistent with clinical diagnosis of mycetoma (Madura foot) – morphology favoring actinomycetoma. Gram stain shows negative staining pattern of filaments. PAS stain shows negative filaments. There is no evidence to suggest malignancy or tuberculosis.

Case Discussion

A farmer presented with midfoot plantar lesion for the last few years. Ultrasound shows a lesion with a dot in a circle sign. Surgical excision of the lesion was done. Histopathology revealed actinomycosis.

Intraoperative photos courtesy of operating surgeon Dr. Niraj I. Patel.

Pathology gross description:

Received a single soft tissue piece, brown–white, measuring about 45 x 25 x 20 mm, weighing 9.6 grams. It is covered on one side by skin measuring about 45 x 20 mm. Cut surface is yellow-white showing pale white necrotic granules. Smears prepared from necrotic tissue and sections processed from different areas.

Pathology report courtesy of Dr. Bharat D. Tandel.

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