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


Answer: Myxofibrosarcoma



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






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




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


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






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.