A 55yr old male patient has swelling and pain in the 2nd toe of left leg since last 2 months and has no past history of any disease. ( Mri reveals - Lytic expansile altered signal intensity lesion in proximal phalynx of 2nd toe with extension to adjacent interphalangeL joint and adjacent soft tissues.) what is the probable diagnoses ?



Good evening, revered kind sirs and madams. Revered Dr. Nayeem has posted a very interesting clinical case with a pictograph of a toe mass. Salient features of clinical history and presentation as posted by revered Dr. Nayeem : 55 Year male, with 2 month history of a bulbous swelling of proximal phalanx of left second toe. Associated with pain. No past history of any disease. MRI reveals lesion to be LYTIC, EXPANSILE, ALTERED SIGNAL INTENSITY, SOFT TISSUE INVOLVEMENT, EXTENSION INTO ADJACENT INTER-PHALENGEAL JOINT. Probable diagnosis : GIANT CELL TUMOR OF LEFT, SECOND TOE. Please Note : 1) 80% of the GCTs occur in age group of 30-50 years of age ( Although the age of the patient in the present case is somewhat similar). 2) Pain and swelling are the most common presenting features. ( as in present case) 3)1-2% of GCTs occur in foot. DDs : 1) Enchondroma. 2) Chondromyxoid fibroma. 3) Aneurysmal bone cyst.

think in terms of TB , gout , enchondroma, lastly mortons neuroma. ....If high risk behaviour also rule out syphilis

pyogenic osteomyelitis can always be taken as a diagnosis and Freiberg disease may rarely present like this ..........FNAC /tissue biopsy is contemplated

Gout ? RA?

tb of phalanx

agree with dr husain

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