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Chondromyxoid fibroma is a rare cartilaginous benign bone tumour constituting less than 1% of cases of primary bone tumours. It is seen most frequently around the knee in children and young adults. Only up to 17% of cases may occur in the foot, where atypical and more aggressive radiological appearances are noticed. A case report is demonstrated, discussing the problems of misdiagnosis. A brief review of the literature is presented. A 32-year-old Filipino female presented with a slightly painful swelling of the second toe of the right foot of around 1 year duration. She gave a history of an inversion injury preceding the presenting symptoms. This was treated by a bandage and analgaesics. She continued to have residual mild discomfort with weight-bearing which she ignored until the appearance of the swelling several months later. The swelling continued to grow very slowly with little discomfort.

We describe a patient with a 2-month history of right shoulder monoarthritis and fever as the presenting symptoms of a subsequent diagnosis of chronic myeloid leukemia in blast crisis. Imaging studies showed changes consistent with leukemic infiltration of the soft tissues around the right shoulder joint and the proximal humerus. Immunophenotypic and morphologic analysis of the large number of cells obtained from the synovial fluid confirmed the shoulder synovitis to be an extramedullary manifestation of myelomonocytic blast crisis of chronic myeloid leukemia. The patient was not a candidate for aggressive chemotherapy treatment because of her poor overall condition, and she had no compatible donor for allogenic bone marrow transplantation. Her painful arthropathy was refractory to standard pain management but she achieved excellent pain relief with palliative radiation therapy. We conclude that the involvement of extramedullary sites by chronic myeloid leukemia blast cells can predate hematological blast crisis in some of chronic myeloid leukemia cases. Also, painful leukemic synovitis can be managed by low dose radiotherapy in a candidate who is refractory to chemotherapy and other medical therapy.

Moyamoya disease is an uncommon clinical entity, characterized by bilateral occlusion of the internal carotid artery and the development of collateral arteries. An 18-year-old Saudi male with systemic lupus erythematosus (SLE) presented with mild right hemiparesis, followed by recurrent ischemic stroke. Cerebral angiography showed bilateral internal carotid artery stenosis associated with the development of collateral circulation (moyamoya vessels). There was no evidence of active SLE or other risk factors for cerebral occlusion, such as antiphospholipid antibody syndrome. Medical and surgical interventions did not influence the poor outcome of the recurrent ischemic insults.