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Age / Sex : /
Age/Sex : 58/M
C.C.: multifocal palpable superficial soft tissue masses
1) What is your impression?
Courtesy : Jee Young Kim, MD Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea
Diagnosis: cutaneous neurofibroma with type I Neurofibromatosis
Discussion
Findings:
- Sagittal T1-weighted image shows multifocal hypointense soft-tissue masses in the subcutaneous fat layer, abutting against skin, indicative of neurofibromas.
- Sagittal fat-suppressed T2-weighted image shows hyper-intense signal in the masses.
- Gadolinium-enhanced T1-weighted image homogeneously enhanced masses.
Differential Diagnosis:
Cutaneous Lymphoma, Kaposi Sarcoma
Diagnosis: Cutaneous neurofibroma
Discussion:
•Cutaneous and subcutaneous involvement of neurofibroma is common in type 1 neurofibromatosis.
•Typically, an entering and exiting nerve cannot be identified in superficial lesions; however, the typical fusiform shape, signal intensity, and enhancement pattern often are present.
•The most common MR appearance of superficial lesions in type 1 neurofibromatosis is a diffuse, poorly defined focus of heterogeneous signal intensity on T2-weighted images
•Classic peripheral nerve sheath tumors have a signal that is isointense to that of skeletal muscle on T1-weighted MR images and hyperintense to that of skeletal muscle on T2-weighted images, with variable degrees of inhomogeneity and enhancement.
References:
1. Blacksin MF, HA DH, Hameed M, Aisner S. Superficial soft-tissue masses of the extremities. Radiographics. 2006 Sep-Oct; 26(5):1289-304.
2. Beaman FD, Kransdorf MJ, Andrews TR, Murphey MD, Arcara LK, Keeling JH. Superficial soft-tissue masses: analysis, diagnosis, and differential considerations. Radiographics. 2007 Mar-Apr;27(2):509-23.
3. Lim R, Jaramillo D, Poussaint TY, Chang Y, Korf B. Superficial neurofibroma: a lesion with unique MRI characteristics in patients with neurofibromatosis type 1. AJR Am J Roentgenol. 2005 Mar;184(3):962-8.
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