Podiatry resident discovers rare cancer, placing patient on path to healing
Jason A. Piraino, D.P.M.
One morning in 2013, Jurline Revels woke up ready to begin her day. As she got out of bed and placed both feet on the floor, she felt a severe pain shoot through her right foot. It was unlike anything she had ever experienced, making it incredibly painful to walk. She examined the bottom of her foot, but it seemed fine.
“It was excruciating,” Revels recalled. “I thought it was unusual, but I went about my day thinking it would go away. The pain lingered so I went to get it checked, but the doctor didn’t find anything.”
Revels continued to deal with the pain. Every day for a year, she walked to and from work, ignoring the agony of each step. In 2014, Revels was laid off. She planned to get her foot examined again now that she had the time. However, her mother fell ill, and extenuating circumstances prevented her from scheduling a doctor’s appointment.
All of Revels’ attention went to her mother, who was diagnosed with cancer. “I had to take care of her,” Revels said. “I put my pain aside to take care of her. When she passed in January of 2016, my daughter said, ‘Mom, it’s time. You need to get your foot checked.’”
For three years, Revels dealt with the torment in the bottom of her right foot. Only now, there was a visible lump. In July 2016, Revels made an appointment at UF Health Jacksonville, where she met with Kyle Mauk, DPM, a podiatry resident. Mauk examined Revels’ foot and immediately knew something was terribly wrong. He consulted Jason Piraino, DPM, podiatry residency director, on how best to proceed.
“When I saw Jurline, she had this mass that was slowly increasing in size,” Mauk said. “It was extremely painful, and she hadn’t been able to put her full weight on her foot for almost two years. We ordered plain film X-rays, which were normal. Based on the size of the mass, we also ordered an MRI.”
Kyle Mauk, D.P.M.
The MRI showed a mass located in the space between the third and fourth metatarsal, with bone erosion and spotty calcification. When Mauk and Piraino reviewed the MRI, they immediately knew they had to involve surgeon Scott Lind, MD.
“I showed Dr. Lind the images, and he said we needed to get her in for a biopsy as soon as possible,” Piraino said. “She came in for the biopsy in October, and we learned it was a synovial sarcoma.”
A synovial sarcoma is a rare form of cancer that typically occurs in the soft tissue near larger joints, such as the knees or shoulders. A tumor like this is rarely found in the foot.
“Sarcomas account for 1 percent of all cancers,” Lind explained. “In adults they’re pretty rare, and there are fewer than 20,000 sarcomas nationally a year. For a foot sarcoma, there’s probably fewer than 1,000 in the country.”
Revels was stunned. She had never heard the word “sarcoma” before her diagnosis. She had no idea how this tumor had formed or what caused it. Lind explained there are no known risk factors for this type of cancer. The physicians discussed chemotherapy and radiation with Revels, but the tumor was extensive and her bones were disintegrating. They opted to remove the tumor and amputate the front portion of her right foot.
“The tumor was eating my whole foot up,” she said. “It was stunning to know it was cancer and then learning my foot had to be amputated. It was devastating.”
In November 2016, Lind and his team removed the tumor, and then Piriano and Mauk performed the amputation. The team ran tests to ensure the cancer had not spread, as this type of tumor can sometimes advance to the lungs or liver. Luckily for Revels, this was not the case.
Even though it was a difficult decision, Revels knew amputation was the right course of action. She trusted Mauk and Piraino and was prepared to fight this deadly disease not only for herself, but also for her family.
“The only thing I could think of was my daughter, my grandson and my father,” Revels said. “My mom had just passed from cancer, so it was hard, but I was grateful for the doctors. They made sure it wasn’t in my bone and hadn’t traveled. I was so blessed.”
Revels is still healing from the surgery and eager to start treatment at UF Health Rehabilitation Services – Jacksonville. She will also be fitted for an in-shoe prosthesis. She knows life will never be the same, but she works hard to stay positive. She shares her story and lives life as normally as possible.
“I make a conscious effort not to feel sorry for myself, but I have my moments,” she said. “I’m teaching myself different ways of doing things, and I’m adjusting well. I’ve been independent most of my life, so I’m learning to slow down — there’s no rush.”
Working as a multidisciplinary team, Revels’ providers were not only able to save most of her foot, but her life as well. The quick involvement of the surgical staff made a huge difference in her quality of life. If the tumor had progressed any further, the team would have had to perform a below-the-knee amputation.
“We were concerned for her when we saw this,” Mauk said. “I’m glad we were able to intervene so quickly. She had a good outcome, and I’m happy for her.”
Although her life has forever changed, Revels is hopeful for the future. At only 47 years old, she strives to remain independent and as active as possible. She is thankful for the quality of care she received at UF Health Jacksonville and for the entire staff for saving her life.
“I thank the hospital and the doctors for examining and diagnosing it,” Revels said. “Everyone here is excellent — from the people I check in with to the nurses and everybody in between. They are wonderful. I’ve never been more pleased.”
Podiatry resident recognized
Kyle Mauk, DPM, a third-year podiatry resident at UF Health Jacksonville, attended the Florida
Podiatric Medical Association Science & Management Symposium in January. Every year, residents from all over the state present interesting cases from their programs. This year, Mauk presented Jurline Revels’ diagnosis and came in first place during the American College of Foot and Ankle Surgeons Division 5 Annual Resident Case Forum. The judge’s criteria is based on complexity of the pathology, management of the patient and overall presentation of the case.
“People were really impressed with the management, the interdisciplinary approach and the pathology,” Mauk said. “The pathology was so unique and not often seen in the foot and ankle. It’s also one of the rare foot and ankle pathologies that, if not identified in a timely fashion, can take a patient’s life.”
Mauk has been offered a position at UF Health Jacksonville that he plans to assume after graduating from the residency program in June. Winning the case presentation two years in a row solidifies this podiatry residency as the best training program in the state, if not the entire Southeast, according to Mauk.
“Kyle did an amazing job presenting the case,” Piraino said. “We’re going to keep him on as faculty next year, and there’s a reason for that — it’s work like this.”
Jason A. Piraino, D.P.M.