Weekly Case

Title : Case 650

Age / Sex : 50 / F


Chief complaint : Calf mass

What is your diagnosis?

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

Courtesy : Hee Jin Park, Kangbuk Samsung hospital



Discussion









Answer: Myxofibrosarcoma


 


Findings:


Well defined oval shaped mass


Subcutaneous layer, abutting the peroneus fascia


T1: Intermediate SI


T2: Heterogeneous high SI


Perilesional edema along the fascia with enhancement


Contrast enhancement: Heterogeneously intense enhancement


 


Differential Diagnosis:


Synovial sarcoma


Unusual peripheral nerve sheath tumor


 


Diagnosis: 


Myxofibrosarcoma


 


Discussion:


Malignant soft tissue tumor


 


Previously known as myxoid malignant fibrous histiocytoma


 


Typically presents in elderly (6th decade)


Male predilection


Patients often present with painless enlarging soft tissue mass in extremities


 


MRI


T1


Intermediate (to low) SI


Heterogeneity if hemorrhage, calcification, necrosis present


Prominent enhancement of solid components


Especially in tumor periphery due to central location of hemorrhage, necrosis and myxoid component


T2


Intermediate to high SI


Heterogeneity if hemorrhage, calcification, necrosis present


Frequently shows curvilinear extensions of high T2 signal along fascial plane that also enhance → “tails” represent fascial extension of tumor at histopathological examination


 


 


 


 


References:


1. Origin and classification of soft tissue tumors. In: Kransdorf MJ , Murphey MD. Imaging of soft tissue tumors. 2nd ed. Philadelphia, Pa: Lippincott Williams & Williams, 2006; 1–5


2. Kransdorf MJ . Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. AJR Am J Roentgenol 1995;164:129–134


3. Jones BC , Sundaram M , Kransdorf MJ . Synovial sarcoma: MR imaging findings in 34 patients. AJR Am J Roentgenol 1993;161:827–830


 




Correct Answer
Total applicants 27 Correct answers 10
Name Institution
이지현 삼성서울병원, 전문의
이진영 전문의
손우곤 전공의
김동언 국군양주병원, 전문의
김기욱 국군수도병원, 전문의
윤유성 순천향대 부천병원, 전문의
백승진 분당차병원, 전공의
신재환 국군춘천병원, 전문의
김형민 전문의
정예나 전공의
Semi-Correct Answer
Total applicants 27 Semi-Correct answers 4
전인환 전문의
강지희 서울대학교병원, 전문의
홍상협 군의관, 전문의
이혜란 전문의


  • 관리자 ( 2019-12-18 14:02:32 )
    benign soft tissue tumor는 틀린 것으로 하였고, malignant soft tissue tumor 또는 sarcoma는 semicorrect로 하였습니다.

Comment