Weekly Case

Title : Case 556

Age / Sex : 35 / F


Chief complaint : Papable mass at the left forearm

What is your impression?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy of Sekyoung Park, Kosin University Gospel Hospital  


 



Discussion


Answer:  Nodular fasciitis


 


Findings: Magnetic resonance imaging revealed a subcutaneous mass at the left forearm. The mass exhibited low to intermediate signal intensity on axial T1-weighted image and high signal intensity with perilesional edema on axial T2-weighted and coronal fat-suppressed T2-weighted images. Axial and coronal fat-suppressed Contrast-enhanced T1-weighted images demonstrated heterogenous enhancement with linear extension along the fascia (fascial tail sign).


 


Differential Diagnosis: Epithelioid sarcoma, Dematofibrosarcoma protuberans, Desmoid-type fibromatosis


 


Discussion:


Nodular fasciitis is a pseudosarcomatous benign fibrous tumor that is thought to be reactive in etiology and, therefore, to be self-limiting. It is primarily located in the upper extremities in young adults (ages 20–40 years). It has been known that nodular fasciitis represents 11 % of all benign soft tissue tumors and comprises 38 % of benign soft tissue tumors in the upper extremity in persons aged between 24 and 45. At MR imaging, nodular fasciitis demonstrates a nonspecific signal intensity. After the administration of contrast material, there is usually diffuse enhancement. An important diagnostic feature at MR imaging is the linear extension of the lesion along the fascia (fascial tail sign), which also may appear enhanced. Locally aggressive imaging features such as trans-compartmental spread and osseous involvement may be seen in cases of documented nodular fasciitis.


 


References


Weiss SW, Goldblum JR. Enzinger and Weiss’s soft tissue tumors. 4th ed. St. Louis, Mo: Mosby, 2001; 535–569, 1483–1571.


Kransdorf MJ. Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location. AJR Am J Roentgenol. 1995;164:395–402


Coyle & L. M. White & B. Dickson & P. Ferguson & J. Wunder & A. Naraghi. MRI characteristics of nodular fasciitis of the musculoskeletal system. Skeletal Radiol (2013) 42:975–982


Francesca D. Beaman, MD2, Mark J. Kransdorf, MD, Tricia R. Andrews, MD, Mark D. Murphey, MD Superficial Soft-Tissue Masses: Analysis, Diagnosis, and Differential Considerations RadioGraphics 2007; 27:509–523


 


To submit your answer, login first (for Korean radiologists) or send e-mail to balgundol@gmail.com (for non-Korean radiologists)

Correct Answer
Total applicants 35 Correct answers 20
Name Institution
김미선 전문의
박재일 대구 척탑병원, 전문의
김영준 전문의
윤유성 구례병원, 전문의
이승훈 한양대학교병원, 전문의
김태형 전문의
엄혜정 전문의
이연옥 선한목자병원, 전문의
이혜란 전문의
곽민지 강동경희대학교 병원, 전문의
조신영 웰튼병원, 전문의
박지원 전문의
김완태 중앙보훈병원, 전문의
김보람 전공의
이규정 고대구로병원, 전문의
송윤아 전문의
이은채 전문의
서지운 전문의
최희석 전병원, 전문의
노정현 전문의


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