Age / Sex : 33 / F

Age / Sex :
33/F

Chief complaint : Left flank pain (D: 5 years)

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)

Courtesy : Lee Jee Young, Dankook University Hospital

Deep Fibromatosis (Extraabdominal Desmoid Tumor)

Discussion

Findings:

MRI showed a bulky dark signal intensity mass in the left iliopsoas muscle on all image sequences. The mass showed ill-defined margin within the iliopsoas muscle and contained some portion of high singal intensity on T2WI and intense enhancement on Gd-enhanced fat suppressed T1WI. There were linear scar tissues in the lateral abdominal wall, indicating previous operation.

Diagnosis: Deep Fibromatosis (Extraabdominal Desmoid Tumor)

Discussion: The musculoskeletal fibromatoses comprise a wide range of lesions with a common histopathologic appearance. They can be divided into two major groups: superficial and deep. The superficial fibromatoses are typically small, slow-growing lesions and include palmar fibromatosis, plantar fibromatosis, juvenile aponeurotic fibroma, and infantile digital fibroma. The deep fibromatoses are commonly large, may grow rapidly, and are more aggressive. They include infantile myofibromatosis, fibromatosis colli, extraabdominal desmoid tumor, and aggressive infantile fibromatosis. MRI demonstrates lesion extent. Involvement of adjacent structures is common, reflecting the infiltrative growth pattern often seen in these lesions. MR imaging may show characteristic features of prominent low to intermediate signal intensity and bands of low signal intensity representing highly collagenized tissue. However, fibromatoses with less collagen and more cellularity may have nonspecific high signal intensity on T2-weighted images. Local recurrence is frequent after surgical resection due to the aggressive lesion growth. It is important for radiologists to recognize the imaging characteristics of musculoskeletal fibromatoses to help guide the often difficult and protracted therapy and management of these lesions.

References:

1.     Murphey MD, Ruble CM, Tyszko SM, Zbojniewicz AM, Potter BK, Miettinen M. From the archives of the AFIP: musculoskeletal fibromatoses: radiologic-pathologic correlation.Radiographics. 2009;29(7): 2143-2173.

2.     Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ. Imaging of musculoskeletal fibromatosis. Radiographics. 2001;21(3):585-600.