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This question was answered on Wed 15, Dec 2010 01:21pm by bobby s, md

Soft-tissue tumor in foot


    
Asked by softtumorinfoot (Female; 24; Nothing significant. Just normal viruses. I had pneumonia once as a child, a kidney infection once as a teenager, and I have fairly severe skin allergies to a variety of chemicals found in cosmetics (quaternium-15, formaldehyde releasing preservatives, isothiazolinones). I work in a biological research lab where I can potentially be exposed to carcinogenic chemicals, but I am very careful. I have never had a major illness or surgery.; Relevant drugs:Vyvanse, Adderal, Jolessa (bcp), daily multivitamin, calcium supplement, iron supplement ) on Thu 28, Oct 2010 04:08pm

I have a soft tissue tumor in my left foot, between the first and second metatarsal. It is inside of my foot, just deep to the fatty pads on the plantar surface of the foot. It is big enough that it visibly protrudes from the bottom of my foot, but only slightly. Its really only visibly noticeable when comparing the left foot to the right foot. Originally I thought it was a neuroma because it was hurting when I walk, so I went to a podiatrist, but he said its the wrong size and wrong place. He then thought it was a ganglion cyst and tried to drain it (which was super painful) but it was solid, so he said its a soft-tissue tumor (it didn't show up at all on an x-ray I had at his office). I had an MRI and the radiologists impressions were that it looks like it "may be" a vascular tumor caused by an AVM and that it was about a centimeter in diameter. The MRI was without contrast, so to my (totally untrained) eye it just looked like everything in the area was gray - the mass did not appear different at all from the surrounding tissue. I asked my general practitioner to look at it and he couldn't read it well, but he said "it doesn't really look like cancer." Whatever that means... My podiatrist then said I should have surgery to have it removed. He said that AVMs in the foot are very rare, and associated tumors are more rare, but that he sees them a couple times a year (he is at huge medical center in a huge city). That was about2 weeks ago, and I have the surgery scheduled for November 12th. Since then the mass has grown visibly so that it now protrudes not just in the middle of my foot but also proximal to the ball of my foot under my big toe. It is also now painful when there is pressure on the top of my foot, not just the bottom. When I asked if they would biopsy the tumor before surgery he said no because it is small and because biopsy through the bottom of my foot would be painful, so they will just take it out and then send it to a pathologist. A little background: I have been suffering from unexplained severe fatigue for almost a year, to the point where I can barely function. I am 24 years old and a usually very healthy, active (female) grad student. After many doctor visits where no tests showed any problems (blood count, electrolytes, liver/kidney function, ANA, ESR, TSH, and a bunch of endocrine hormone levels were all normal), except that my ferratin is consistently very low, fasting glucose is high (but glycosylated hemoglobin was normal), and my C-reactive protein was high two of three times it was measured. My fatigue was so bothersome that I now take two different prescribed amphetamines just to function at a normal level during the day, then I sleep like a log 10-12 hours a night. My concern is that no one has as definitively checked to see what kind of tumor it is and whether it is benign or not. I have given into my paranoia and looked at pictures of soft tissue sarcoma MRIs online, and to my untrained eye my MRI looks similar. I know it would be extremely unlikely for someone my age to get a cancerous tumor in her foot, but I am feeling a bit uncomfortable that the only opinions I've had on it are from a radiologist, a GP, and a podiatrist (who is not an MD) and that no one is really sure what the mass is. The recent history of severe fatigue also worries me. It does make sense that a biopsy would be invasive and painful to test something that is most likely not cancer.. but at the same time I am really worried about the possibility that it could be malignant and that the podiatrist would seed the cancer all over the place when removing the tumor. Do you think there is enough here to see an oncologist before doing the surgery? Are there blood tests that could rule out cancer (like would I have a higher white blood count), or are there tumor markers that could be easily checked for? Or do my doctor's recommendations sound reasonable and I am just over-reacting? Thanks so much for your opinion.

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Answer by bobby s, md  on Wed 15, Dec 2010 01:21pm:

Hello,
I apologize for the delay in replying. The podiatrist was unable to drain the "tumor" with a needle, and deemed it "solid". Next, the "tumor" was suspected to be a vascular AVM. These two are inconsistent with each other. An AVM can usually be diagnosed by using appropriate imaging techniques.
I would be interested in an update from you, and how the surgery went, and what the result was.
All the best, and God Bless!

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