Primary Epithelioid Angiosarcoma of the Calcaneum: A Diagnostic Dilemma

Primary epithelioid angiosarcoma of the bone is very rare. We report a rare case of epithelioid angiosarcoma of the calcaneum and the difficulties we had in diagnosing this condition. A 22-year-old woman presented with complaints of pain and swelling of the left ankle of 8 years' duration. Examination revealed swelling and tenderness over the lateral aspect of calcaneum. Plain radiographs showed an osteolytic lesion of the calcaneum. She underwent curettage and bone grafting, with bone substitutes. Histopathologic examination showed epithelioid angiosarcoma in contrast to the needle biopsy, which had showed an aneurysmal bone cyst. The patient was counseled about the need for amputation. She refused limb ablative surgery, and the likelihood of local recurrence and systemic spread and the need for close follow-up were explained. At the end of 3 years of follow-up, she was pain free and had no evidence of recurrence. We present this case because of the rare site, histopathologic challenges in diagnosing the condition, and unique presentation of the disease.