Case report
NEGLECTED RUPTURE OF PERONEAL TENDON THAT PRESENTED AS TUMOR FORMATION
IVAN BOJANIĆ
orcid.org/0000-0002-4236-9637
; Zagreb University Hospital Center and University of Zagreb, School of Medicine, Department of Orthopedic Surgery, Zagreb, Croatia
ANA GILJANOVIĆ
; University of Zagreb, School of Medicine, Zagreb, Croatia
KREŠIMIR MAJDANČIĆ
; Vinkovci General County Hospital, Department of Orthopedics and Traumatology, Vinkovci, Croatia
DAMJAN DIMNJAKOVIĆ
; Zagreb University Hospital Center and University of Zagreb, School of Medicine, Department of Orthopedic Surgery, Zagreb, Croatia
Abstract
Introduction: The goal of this article is to present a case in which surgical treatment was indicated to remove a soft tissue mass adjacent to the fi bular malleolus. The mass was supposed to be a giant cell tumor (GCT) of the peroneal tendon sheath, based on the magnetic resonance imaging (MRI) fi ndings and its localization. Case report: A 57-year-old male came to our outpatient clinic complaining of a soft tissue mass adjacent to the fi bular malleolus of the right foot. He fi rst noticed the mass 2 years before, after sustaining a blunt injury of the lateral part of the right foot while playing basketball. Initially, the patient noticed a swelling in this area, which later hardened but was always painless and with well-defi ned borders. At the time of the examination, the patient had already undergone MRI of the right foot and ankle, which was suspicious of GCT of the peroneal tendon sheath. Surgery was indicated to remove the supposed tumor. At surgery, a longitudinal rupture of the peroneus brevis (PB) tendon was found, splitting the tendon in two parts, with the larger part being formed in a way that it mimicked a tumorous mass. Excision of the ruptured part of the PB tendon was done, followed by tenodesis to the peroneus longus tendon. Histopathologic diagnosis of the excised ruptured tendon showed pseudocystic degeneration of the tendon and no signs of tumorous tissue. The patient recovered fully and was symptom-free at the fi nal follow-up, 36 months after the surgery. Discussion: When rupture of peroneal tendon occurs, debridement of the ruptured part is always suggested. If, following debridement, the remaining part of the tendon is larger than 50% of the initial diameter, the surgeon can decide either to leave the tendon as it is, or to perform tendon tubularization. If, following debridement, the remaining part of the tendon is smaller than 50% of the initial diameter, resection of the remaining tendon is suggested. Afterwards, in cases of PB tendon rupture, the remaining parts of the PB tendon are sutured to the peroneus longus tendon. The proximal part of the PB tendon is sutured 3 to 4 cm proximal to the tip of the fi bula, while the distal part of the PB tendon is sutured 5 to 6 cm distal to the tip of the fi bula. Conclusion: This report shows that the rupture of peroneal tendon with degeneration may present as a painless mass mimicking a tumorous tissue on MRI images and during clinical examination. Thus, the defi nitive and correct diagnosis can sometimes be made only during surgery and confi rmed later by histopathologic analysis. Furthermore, treatment of our patient confi rmed the results from the literature, which suggest tenodesis of peroneal tendons as a viable treatment option in cases where a single tendon is completely ruptured or otherwise unusable.
Keywords
peroneal tendons; rupture; giant cell tumor; tenodesis
Hrčak ID:
273938
URI
Publication date:
16.3.2022.
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