Case Discussion

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Hello everyone,
Long time listener, first time caller.

Brief description of a case that's been referred out to a larger specialty clinic with more resources.

Male 30yo, noticed a small(<5mm) bump on the sole of his foot 6 months prior. Presented to GP 2 months ago after noticing it was visible through his sock.

Examined with patient in dorsiflexion.

Initial exam, the mass is deeply fixated to the anterior of the medial aspect of the plantar aponeurosis, with palpable margins measuring 28mm x 15mm ~8mm raised. The consistency was firm, multilobulated, and the patient expressed mild discomfort when assessing the extent of fixation to adjacent structures. MR with and without contrast ordered.

Post MR follow-up, nearly identical characteristics of the mass, with longitudinal and axial growth. Now measuring 32mm x 15mm x 10mm.

XR interpretation was negative.
MR c-/c+ interpretation was negative.

Familial history of multiple neoplasms:

• Sister, amelanotic melanoma, DX'd at 29yo, succumbed to disease in <4 months.
• Father, stage IIIC prostatic carcinoma, remission >10yrs.
• Grandmother, paternal, unspecified esophagus cancer, deceased.
• Uncle 1, paternal, unspecified lung cancer, deceased.
• Uncle 2, paternal, unspecified liver cancer, deceased.

Again, the patient has been referred to a larger specialty clinic, but as a learning opportunity, I would appreciate any DDX suggestions, as well as any theories on the unremarkable MR interpretation.

My two theories are;
1) "The wrong camera for the picture", the only available MR was 1.5T.

Or

2) "The drummer had a bad set", an overworked radiologist in a rural setting, and I received his interpretation ~30mins after the patient's exam was scheduled. Seems a little expeditious for the scan, let alone a thorough review?