A soft tissue nodule on the foot.

A 70-year-old Surinam woman visited the hospital because of a subcutaneous swelling on the instep of her left foot. She had had this problem for several years, but recently she was experiencing more pain when wearing certain shoes. Physical examination revealed a tender swelling on the foot without any other abnormalities. The clinical diagnosis of a ganglion was made. At surgical excision, however, a more solid lesion was removed and sent in for histopathological examination. The histological findings showed a sharply demarcated nodule, consisting of partly concentrically arranged fibrous tissue (figure 1). The central area was composed of spherical structures (grains) surrounded by abundant neutrophils, necrotic debris and demarcated by a rim of palisaded epitheloid histiocytes and multinucleated giant cells (figure 2).