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CASE: This case report describes a patient who presented with clinical and radiographic features of a soft tissue sarcoma of the shoulder. Despite having a painless and relatively large mass, a biopsy and resection revealed nodular fasciitis (NF). CONCLUSION: This is an unusual case of a painless 10 cm mass that histopathologically was diagnosed as NF in the upper extremity with proximity to the axillary nerve and posterior humeral circumflex vessels. The USP6 rearrangement was helpful in confirming the diagnosis. Careful clinical, radiographic, and pathologic correlation is necessary in diagnosing these relatively rare tumors. In cases where there are discordant findings, molecular markers can be very helpful.
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Fascitis , Sarcoma , Hombro , Humanos , Fascitis/diagnóstico por imagen , Fascitis/patología , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Sarcoma/cirugía , Hombro/diagnóstico por imagen , Hombro/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Masculino , Femenino , Diagnóstico DiferencialRESUMEN
PURPOSE: To investigate the value of multi-parametric MRI-based radiomics for preoperative prediction of lung metastases from soft tissue sarcoma (STS). METHODS: In total, 122 patients with clinicopathologically confirmed STS who underwent pretreatment T1-weighted contrast-enhanced (T1-CE) and T2-weighted fat-suppressed (T2FS) MRI scans were enrolled between Jul. 2017 and Mar. 2021. Radiomics signatures were established by calculating and selecting radiomics features from the two sequences. Clinical independent predictors were evaluated by statistical analysis. The radiomics nomogram was constructed from margin and radiomics features by multivariable logistic regression. Finally, the study used receiver operating characteristic (ROC) and calibration curves to evaluate performance of radiomics models. Decision curve analyses (DCA) were performed to evaluate clinical usefulness of the models. RESULTS: The margin was considered as an independent predictor (p < 0.05). A total of 4 MRI features were selected and used to develop the radiomics signature. By incorporating the margin and radiomics signature, the developed nomogram showed the best prediction performance in the training (AUCs, margin vs. radiomics signature vs. nomogram, 0.609 vs. 0.909 vs. 0.910) and validation (AUCs, margin vs. radiomics signature vs. nomogram, 0.666 vs. 0.841 vs. 0.894) cohorts. DCA indicated potential usefulness of the nomogram model. CONCLUSIONS: This feasibility study evaluated predictive values of multi-parametric MRI for the prediction of lung metastasis, and proposed a nomogram model to potentially facilitate the individualized treatment decision-making for STSs.
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Estudios de Factibilidad , Neoplasias Pulmonares , Nomogramas , Sarcoma , Humanos , Femenino , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Masculino , Sarcoma/diagnóstico por imagen , Sarcoma/secundario , Sarcoma/patología , Persona de Mediana Edad , Adulto , Anciano , Estudios Retrospectivos , Imágenes de Resonancia Magnética Multiparamétrica/métodos , Imagen por Resonancia Magnética/métodos , Adulto Joven , Curva ROC , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/secundario , Neoplasias de los Tejidos Blandos/patología , RadiómicaRESUMEN
Epithelioid haemangioendothelioma (EH) is a rare malignant vascular tumour occurring mainly in the liver and lungs, with bones being a rare site and primarily seen in the adult population. This case presents a male patient in his 40s who presented to the outpatient department with a chief issue of a painless swelling over the inguinal region for 4 months, gradually increasing in size, along with a history of a gradually enlarging, painless mass on his left knee over the past 5 years. Despite occasional discomfort during physical activities, the mass exhibited no associated trauma, fever, weight loss or systemic symptoms. Physical examination revealed a firm mass on the left knee and a matted lymph nodal swelling in the left inguinal region. Subsequent imaging studies identified multiple soft tissue lesions, osseous involvement and pulmonary metastases, suggestive of multicentric haemangioendothelioma. The patient underwent surgical excision of the inguinal mass and fixation of a pathological fracture in the left femur. He is currently undergoing chemotherapy and is scheduled for regular follow-up appointments. This case underscores the importance of thorough diagnostic evaluation and multidisciplinary management in complex oncological conditions like multicentric haemangioendothelioma.
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Hemangioendotelioma Epitelioide , Humanos , Masculino , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/cirugía , Hemangioendotelioma Epitelioide/diagnóstico por imagen , Adulto , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/terapia , Diagnóstico Diferencial , Neoplasias Pulmonares/diagnóstico , Fracturas Espontáneas/diagnóstico por imagen , Fracturas Espontáneas/etiología , Fracturas Espontáneas/cirugía , Neoplasias Óseas/diagnósticoRESUMEN
Malignant soft tissue tumors, in particular, require a multimodal treatment concept involving interdisciplinary cooperation between radiologists, pathologists, surgeons and oncologists at special tumor centers. The foundations of the treatment decision are the imaging diagnostics and the diagnosis confirmation based on tissue samples. The (local) extent and growth behavior of a tumor are among the most important findings of imaging as they have a direct influence on the surgical procedure. The most important diagnostic procedure here is magnetic resonance imaging (MRI). The T1-weighted and fat-suppressed sequences after i.v. contrast administration are used to visualize the extent of the tumor. In synopsis with diffusion-weighted and T2-weighted sequences, a differentiation between vital tumor tissue and tumor necrosis is additionally possible. This also enables targeted sampling from vital tumor parts so that the patient can be assigned to the appropriate treatment concept as quickly as possible.
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Imagen por Resonancia Magnética , Neoplasias de los Tejidos Blandos , Humanos , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Imagen por Resonancia Magnética/métodos , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/terapiaRESUMEN
BACKGROUND: Myxofibrosarcoma is a myxoid soft tissue sarcoma showing T2 high intensity on magnetic resonance imaging. However, myxofibrosarcoma is a heterogeneous sarcoma with both myxoid and cellular portions. Magnetic resonance imaging findings were obtained MRI findings for comparison with histological and Ki-67 immunohistochemical features, in different portions of one myxofibrosarcoma. CASE PRESENTATION: Magnetic resonance imaging observations were compared with gross pathological and microscopic findings of a myxofibrosarcoma from a 50-year-old Japanese female. The Ki-67 labeling indices of different portions of the tumor, that is, the myxoid, cellular, and histologically confirmed infiltrative margin portions (pathological tail sign), were compared. The T2 low intensity area was more cellular than the T2 high intensity area, while the cellular portion had a significantly higher Ki-67 index than the myxoid portion (p = 0.0313). The portions with the pathological tail sign had a significantly higher Ki-67 labeling index than those without this sign (p = 0.0313). CONCLUSIONS: More cellular portions of a myxofibrosarcoma correspond to more areas of the tumor showing aggressive features. Furthermore, our data also support the hypothesis of high aggressiveness being associated with the pathological tail sign in myxofibrosarcoma. To our knowledge, this is the first case report to describe comparisons among the imaging findings, histological features, and Ki-67 immunohistochemistry results for different portions of one myxofibrosarcoma.
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Fibrosarcoma , Antígeno Ki-67 , Imagen por Resonancia Magnética , Humanos , Femenino , Persona de Mediana Edad , Antígeno Ki-67/metabolismo , Fibrosarcoma/patología , Fibrosarcoma/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
A man in his 20s presented with a painless, slow-growing firm swelling in the anterolateral aspect of his left forearm. The swelling had been present for 1 year and measured 10×12 cm. Clinically, a differential diagnosis of soft tissue sarcoma, lipoma, neurofibroma, dermoid cyst and hydatid cyst of the extremity was considered. MRI suggested a primary intramuscular hydatid cyst. However, fine-needle aspiration was inconclusive, and ELISA for immunoglobulin G antibodies to echinococcal antigen in serum was negative. A wide-local complete surgical excision of the lesion was planned. Intraoperatively, a well-defined, tense cystic swelling with surrounding dense adhesions was found within the intramuscular plane. Histopathological examination of the cyst wall revealed cysticercosis. The patient recovered uneventfully. This case highlights that solitary intramuscular cysticercosis, although rare, should be included in the differential diagnosis of an isolated soft tissue mass, particularly in endemic areas.
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Cisticercosis , Antebrazo , Neoplasias de los Tejidos Blandos , Humanos , Masculino , Cisticercosis/diagnóstico , Diagnóstico Diferencial , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Imagen por Resonancia Magnética , Adulto , Enfermedades Musculares/diagnóstico , Enfermedades Musculares/parasitologíaRESUMEN
OBJECTIVE: The purpose of this study is to evaluate elastography in a wide spectrum of soft tissue superficial lesions by correlating the elastographic characteristics of these lesions with the elastographic score (ES) system established by Asteria. METHODS: Forty patients with different superficial lesions of the soft tissues were studied, including lipomas, schwannomas, neuromas, epidermal inclusion cysts, "in transit" melanoma metastasis, arterio-venous malformation, and giant-cell tumor. An ultrasound examination was performed combined with color-Doppler and elastographic module. The B-mode criteria were echogenicity, margins, and structural homogeneity of the lesion. The color-Doppler criterion was irregular and mainly intra-nodular vascularization. ES 1-4 was attributed, in relation with the increasing tissue stiffness, according to the classification of Asteria adapted for soft tissues. Subsequently, we added to each single B-mode and color-Doppler criterion the ES 3 and 4, thus crossing two parameters of malignancy. All the presumptive diagnoses formulated were confirmed with the clinical data or with the histopathological result. RESULTS: The hypoechoic appearance had the best diagnostic performance. Sensitivity was 87%, specificity 71%, positive predictive value (PPV) 80%, negative predictive value (NPV) 80%, and diagnostic accuracy 80%. There was a good correlation with the clinical and biopsy data, the irregularity of margins the worst performance, the inhomogeneity an intermediate. Color-Doppler had sensitivity 74%, specificity 82%, PPV 85%, NPV 70% and diagnostic accuracy 77.5%. Elastography had sensitivity 87%, specificity 94%, PPV 95%, NPV 84%, and diagnostic accuracy 90%. The combination hypoechoic appearance + ES3/ES4 showed sensitivity 83%, specificity 100%, PPV 100%, NPV 81%,and diagnostic accuracy of 90%. The combination of irregularity of margins + ES3/ES4 showed sensitivity 43%, specificity 100%, PPV 100%, NPV 59%, and diagnostic accuracy of 67.5%. The combination of inhomogeneity of the lesion + ES3/ES4 showed sensitivity 65%, specificity 94%, PPV 94%, NPV 68%, and diagnostic accuracy of 78%. The combination of the color-Doppler with the ES3/ES4 showed sensitivity 69.5%, specificity 100%, PPV 100%, NPV 71%, and diagnostic accuracy of 82.5%.In the combined evaluation, there was a significant increase in specificity, allowing healthy subjects to be categorized as correctly negative, with a reduction in false positives which also translates into an increase in PPV. CONCLUSIONS: Elastography alone is not sufficient for a correct diagnostic classification and must be considered as an additional parameter in the study of soft-tissue lesions. Although there was a good agreement between B-mode malignancy criteria and ES3/ES4, there is no significant improvement in sensitivity. Ultrasound assessment, especially of superficial lesions, cannot be separated from an integrated approach that foresees the additional and routine use of the elastographic examination.
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Diagnóstico por Imagen de Elasticidad , Sensibilidad y Especificidad , Neoplasias de los Tejidos Blandos , Humanos , Diagnóstico por Imagen de Elasticidad/métodos , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Adulto Joven , Ultrasonografía Doppler en Color/métodos , Anciano de 80 o más Años , Adolescente , Mano/diagnóstico por imagenRESUMEN
OBJECTIVE: Elastofibroma dorsi (ED) is a rare benign tumor located in the subscapular region. The aim of this study was to evaluate our clinical findings, surgical approach, and management of ED patients based on single-center data with the relevant literature. METHODOLOGY: A retrospective evaluation was conducted on 20 patients who were operated on for ED. RESULTS: Of the 16 (80%) female patients and 4 (20%) male patients, the main complaint was swelling (80%), and 10 cases (50%) had unilateral involvement. All patients were operated on using standard surgical procedures. Despite a long follow-up period (6-53 months, mean of 26.6 months), no recurrences were observed. Two patients (10%) required simple needle aspiration due to post-operative seroma, and one patient, due to infection, required evacuation (5%). CONCLUSION: Although rare, ED should not be overlooked in patients with swelling in the back region. Our data suggests that surgery can be safely performed in such patients after a clinical and radiological diagnosis of ED has been established.
OBJETIVO: Evaluar los hallazgos clínicos, el enfoque quirúrgico y el manejo de los pacientes con urgencias a partir de los datos de un solo centro y la literatura relevante. MÉTODO: Se realizó una evaluación retrospectiva de 20 pacientes que fueron operados de ED. RESULTADOS: En los 16 (80%), pacientes del sexo femenino y cuatro (20%) del sexo masculino, la queja principal fue la tumefacción (80%) y 10 casos (50%) tuvieron afectación unilateral. Todos los pacientes fueron operados utilizando procedimientos quirúrgicos estándar. Con un largo periodo de seguimiento (6-53 meses, media de 26.6 meses), no se observaron recurrencias. Dos pacientes (10%) requirieron aspiración con aguja simple por seroma posoperatorio y un paciente (5%) requirió evacuación por infección. CONCLUSIONES: Aunque es raro, el ED no debe pasarse por alto en pacientes con hinchazón en la región de la espalda. Nuestros datos sugieren que la cirugía se puede realizar de manera segura en estos pacientes después de haber establecido el diagnóstico clínico y radiológico de ED.
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Fibroma , Neoplasias de los Tejidos Blandos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Fibroma/cirugía , Fibroma/diagnóstico por imagen , Fibroma/patología , Persona de Mediana Edad , Adulto , Anciano , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Seroma/etiologíaRESUMEN
OBJECTIVE: Lipomatous soft tissue tumors (STT), ranging from benign lipomas to malignant liposarcomas, require accurate differentiation for timely treatment. Complementary to MRI, Contrast-enhanced ultrasound (CEUS) is emerging as a promising tool, providing insight into tumor microperfusion in real-time. This study aims to explore the potential of preoperative CEUS in differentiating benign lipomatous tumors from malignant liposarcoma subtypes. METHODS: Eighty-seven patients with lipomatous STT scheduled for surgery were enrolled. Clinical and MRI assessments were conducted to obtain general tumor characteristics. CEUS was used for a standardized tumor perfusion evaluation. Perfusion analysis included peak enhancement, rise time, wash-in perfusion index, and wash-out rate, reflecting the perfusion kinetics. Histopathological results were obtained for every STT and compared to perfusion characteristics. RESULTS: In total, 48 lipoma, 23 ALT and 11 liposarcoma were identified. Significant differences in tumor microperfusion were demonstrated, with higher perfusion levels indicating higher malignancy (Peak enhancement [a.u.] of Lipoma: 145 ± 238; ALT: 268 ± 368; Liposarcoma: 3256 ± 4333; p (ALT vs. Liposarcoma) < 0.001). A perfusion-based identification of a benign lipoma or ALT versus sarcoma resulted in a positive predictive value of 93%. Patient-related factors (age, gender, BMI, ASA score, smoking status) had no significant impact on the CEUS-based perfusion parameters. CONCLUSION: Our study suggests CEUS as a capable non-invasive tool for improving preoperative assessment of lipomatous STT. It can assist in the distinction between benign and malignant STT, accelerating treatment decisions and enhancing patient outcomes. Significant correlations between CEUS-derived parameters and malignancy highlight its risk assessment potential.
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Medios de Contraste , Lipoma , Liposarcoma , Ultrasonografía , Humanos , Liposarcoma/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Lipoma/diagnóstico por imagen , Anciano , Ultrasonografía/métodos , Adulto , Diagnóstico Diferencial , Aumento de la Imagen/métodos , Anciano de 80 o más Años , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Estudios ProspectivosRESUMEN
BACKGROUND: Synovial hemangiomas are rare benign vascular anomalies surrounded by a synovial lining and were first described by Bouchut in 1856. These neoplasms can develop in the intra-articular region, resulting in effusions and knee pain. However, their cause remains unknown. Prompt diagnosis and intervention are critical to prevent chondral damage. Histopathological examination is used to achieve the diagnosis, which is often delayed because of a lack of specific clinical signs. This report describes a unique case in which a painful infrapatellar mass was diagnosed as a synovial hemangioma. The absence of typical magnetic resonance imaging (MRI) findings highlights the importance of arthroscopic excision for diagnosis and symptom relief. CASE PRESENTATION: A 20-year-old woman presented with persistent anterior left knee pain that became exacerbated when she climbed stairs. Despite previous pain management and physical therapy, she developed a painful lump beneath her patella that worsened over time. She had also undergone arthrocentesis, but this did not relieve her pain. Physical examination revealed a palpable, immobile 5-cm mass along the patellar tendon with limited knee flexion and extension and normal ligament stability. T1-weighted fat-saturated MRI of the left knee with gadolinium-based contrast revealed a lobulated intra-articular mass in Hoffa's fat pad that resembled a soft tissue chondroma. A biopsy of the mass was performed to provide histopathological evidence, confirming the benign nature of the mass. The subsequent excisional arthroscopy, combined with incision enlargement for mass removal, confirmed the histopathologic diagnosis of synovial hemangioma based on the presence of numerous dilated blood vessels and venous proliferation within sections of the synovium. Recovery was complete, and no residual tumor was detected on follow-up MRI after 1 year. CONCLUSION: This case study emphasizes the importance of arthroscopic excision over open surgery for patients with synovial hemangioma. The minimally invasive nature of arthroscopy combined with the well-encapsulated nature and location of the mass facilitates complete resection.
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Hemangioma , Articulación de la Rodilla , Imagen por Resonancia Magnética , Membrana Sinovial , Humanos , Femenino , Hemangioma/cirugía , Hemangioma/complicaciones , Hemangioma/diagnóstico por imagen , Hemangioma/diagnóstico , Hemangioma/patología , Adulto Joven , Membrana Sinovial/patología , Membrana Sinovial/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/patología , Articulación de la Rodilla/diagnóstico por imagen , Artroscopía , Dolor Crónico/etiología , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/complicaciones , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Rótula/patología , Rótula/cirugía , Rótula/diagnóstico por imagen , Artralgia/etiologíaRESUMEN
PURPOSE: Radiation induced changes in bone such as radiation osteitis are commonly identified on magnetic resonance imaging (MRI) in patients who receive radiotherapy for soft tissue sarcoma (STS) management. This study proposes a novel MRI scoring system to assess osseous lesions and predict potential for malignancy based on MRI score in STS patients who received radiotherapy. METHODS: The MRI score consisted of 3 parameters: morphology, signal intensity, and progression. Interobserver reliability between MRI scores were analyzed with Cohen's kappa coefficient. Receiver operating curve (ROC) analysis was performed to determine a predictive MRI score for malignancy. RESULTS: 156 MRI's from 30 STS patients who received radiotherapy were retrospectively reviewed. Two (6.7 %) patients developed regional osseous metastasis identified on MRI. The kappa coefficient of the scoring system was 0.785 demonstrating substantial interobserver agreement (p < 0.001). ROC analysis demonstrated that the optimal cut-off value for malignant lesion on MRI was 5.5 (area under the curve 0.998; p < 0.001). CONCLUSIONS: This novel MRI scoring system recommends lesions with a score of six and above to be biopsied to distinguish if malignancy is present. We believe this scoring system can be utilized by multidisciplinary care teams to guide clinical recommendations for patients with STS and MRI findings concerning for malignancy versus radiation induced changes.
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Neoplasias Óseas , Imagen por Resonancia Magnética , Sarcoma , Humanos , Femenino , Masculino , Sarcoma/diagnóstico por imagen , Sarcoma/radioterapia , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/radioterapia , Adulto , Anciano , Reproducibilidad de los Resultados , Estudios Retrospectivos , Anciano de 80 o más Años , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/radioterapia , Sensibilidad y Especificidad , Neoplasias Inducidas por Radiación/diagnóstico por imagen , Neoplasias Inducidas por Radiación/etiologíaRESUMEN
BACKGROUND: Benign bone and soft tissue tumours encompass a broad, heterogenous range of tumours with varying clinical characteristics. These are often managed surgically with either curettage or marginal excision, but unfortunately have high rates of local recurrence. Indocyanine green (ICG) is a fluorescent dye which can be used to identify solid malignancies intraoperatively but its use is not yet established in benign bone and soft tissue tumours. This study aims to assess whether these tumours fluoresce when administered with ICG pre-operatively and whether this helps surgeons to identify tumour intra-operatively. PATIENTS AND METHODS: Patients with locally aggressive benign bone and soft tissue tumours were administered with 25-75 mg of ICG preoperatively at the induction of anaesthesia. Fluorescence was imaged intraoperatively using the Stryker SPY-PHI camera. RESULTS: Of the 12 patients included, 11 tumours fluoresced. The surgeons felt the fluorescence guided the procedure in 7 out of the 11 cases which fluoresced. It was felt to be particularly useful in the curettage of bone tumours, in which curettage could be repeated until the absence of fluorescence on imaging. After 12 months, no patients had local recurrence of the tumour. There were no adverse events recorded in this study and surgeons found the technology acceptable. CONCLUSIONS: The use of ICG for fluorescence guided surgery is a promising technology to improve outcomes of surgery for benign bone and soft tissue tumours. Further, longer term, study with a control arm is needed to identify whether it results in a reduction in the local recurrence rate.
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Neoplasias Óseas , Verde de Indocianina , Neoplasias de los Tejidos Blandos , Humanos , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Femenino , Masculino , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patología , Adulto , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Adulto Joven , Adolescente , Colorantes , Pronóstico , Estudios de Seguimiento , Fluorescencia , Colorantes Fluorescentes , Anciano , Imagen Óptica/métodos , NiñoRESUMEN
PURPOSE: Systematic reviews on the grading of STS using MRI are lacking. This review analyses the role of different MRI features in inferring the histological grade of STS. MATERIALS AND METHODS: A systematic review was conducted and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE were systematically searched for literature addressing the correlation of MRI findings in soft tissue sarcoma with tumor grade. As keywords "MRI", "magnetic resonance imaging", "sarcoma", "grade", "grading", and "FNCLCC" have been selected. RESULTS: 14 studies have been included in this systematic review. Tumor size (p = 0.015 (51 patients) to p = 0.81 (36 patients)), tumor margin (p < 0.001 (95 patients) to 0.93 (36 patients)), necrosis (p = 0.004 (50 patients) to p = 0.65 (95 patients)), peritumoral edema (p = 0.002 (130 patients) to p = 0.337 (40 patients)), contrast enhancement (p < 0.01 (50 patients) to 0.019 (51 patients)) and polycyclic/multilobulated tumor configuration (p = 0.008 (71 patients)) were significantly associated with STS malignancy grade in most of the included studies. Heterogeneity in T2w images (p = 0.003 (130 patients) to 0.202 (40 patients)), signal intensity in T1w images/ hemorrhage (p = 0.02 (130 patients) to 0.5 (31 patients)), peritumoral contrast enhancement (p < 0.001 (95 patients) to 0.253 (51 patients)) and tumoral diffusion restriction (p = 0.01 (51 patients) to 0.53 (52 patients)) were regarded as significantly associated with FNCLCC grade in some of the studies which investigated these features. Most other MRI features were not significant. CONCLUSION: Several MRI features, such as tumor size, necrosis, peritumoral edema, peritumoral contrast enhancement, intratumoral contrast enhancement, and polycyclic/multilobulated tumor configuration may indicate the malignancy grade of STS. However, further studies are needed to gain consensus.
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Imagen por Resonancia Magnética , Clasificación del Tumor , Sarcoma , Humanos , Imagen por Resonancia Magnética/métodos , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patología , Sensibilidad y Especificidad , Reproducibilidad de los ResultadosRESUMEN
Soft tissue vascular anomalies may be composed of arterial, venous, and/or lymphatic elements, and diagnosed prenatally or later in childhood or adulthood. They are divided into categories of vascular malformations and vascular tumors. Vascular malformations are further divided into low-flow and fast-flow lesions. A low-flow lesion is most common, with a prevalence of 70%. Vascular tumors may behave in a benign, locally aggressive, borderline, or malignant manner. Infantile hemangioma is a vascular tumor that presents in the neonatal period and then regresses. The presence or multiple skin lesions in an infant can signal underlying visceral vascular anomalies, and complex anomalies may be associated with overgrowth syndromes. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Sociedades Médicas , Malformaciones Vasculares , Humanos , Malformaciones Vasculares/diagnóstico por imagen , Estados Unidos , Medicina Basada en la Evidencia , Lactante , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Recién Nacido , Niño , Diagnóstico por Imagen/métodos , Hemangioma/diagnóstico por imagen , Guías de Práctica Clínica como AsuntoAsunto(s)
Hemangioendotelioma , Muslo , Humanos , Hemangioendotelioma/patología , Hemangioendotelioma/diagnóstico por imagen , Hemangioendotelioma/cirugía , Hemangioendotelioma/diagnóstico , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Masculino , Femenino , Imagen por Resonancia MagnéticaRESUMEN
We present a novel case of a malignant transformation of an extremity soft tissue angioleiomyoma to leiomyosarcoma in a man in his late 70s who presented with a painful and increasing lump on his anterior tibia. Initial imaging and biopsy showed a benign angioleiomyoma which was excised for symptomatic reasons. An analysis of the resulting specimen revealed a 50×42×15 mm smooth muscle neoplasm consistent with angioleiomyoma with a 22×11 mm entirely intralesional nodular component in keeping with a grade 1 leiomyosarcoma. The malignant constituent of the lesion was entirely encased in benign angioleiomyoma negating the need for further surgery. Systemic staging investigation revealed no evidence of metastatic disease spread final staging as per the eighth edition of the American Joint Committee on Cancer (AJCC) Staging T1N0M0 R0 Stage 1 a.
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Angiomioma , Leiomiosarcoma , Tibia , Humanos , Masculino , Leiomiosarcoma/patología , Leiomiosarcoma/cirugía , Leiomiosarcoma/diagnóstico por imagen , Tibia/patología , Tibia/diagnóstico por imagen , Angiomioma/patología , Angiomioma/cirugía , Angiomioma/diagnóstico por imagen , Anciano , Transformación Celular Neoplásica/patología , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Biopsia , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagenRESUMEN
Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.
Asunto(s)
Ultrasonografía , Humanos , Ultrasonografía/métodos , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Palpación , Diagnóstico DiferencialRESUMEN
BACKGROUND: Volume of interest (VOI) segmentation is a crucial step for Radiomics analyses and radiotherapy (RT) treatment planning. Because it can be time-consuming and subject to inter-observer variability, we developed and tested a Deep Learning-based automatic segmentation (DLBAS) algorithm to reproducibly predict the primary gross tumor as VOI for Radiomics analyses in extremity soft tissue sarcomas (STS). METHODS: A DLBAS algorithm was trained on a cohort of 157 patients and externally tested on an independent cohort of 87 patients using contrast-enhanced MRI. Manual tumor delineations by a radiation oncologist served as ground truths (GTs). A benchmark study with 20 cases from the test cohort compared the DLBAS predictions against manual VOI segmentations of two residents (ERs) and clinical delineations of two radiation oncologists (ROs). The ROs rated DLBAS predictions regarding their direct applicability. RESULTS: The DLBAS achieved a median dice similarity coefficient (DSC) of 0.88 against the GTs in the entire test cohort (interquartile range (IQR): 0.11) and a median DSC of 0.89 (IQR 0.07) and 0.82 (IQR 0.10) in comparison to ERs and ROs, respectively. Radiomics feature stability was high with a median intraclass correlation coefficient of 0.97, 0.95 and 0.94 for GTs, ERs, and ROs, respectively. DLBAS predictions were deemed clinically suitable by the two ROs in 35% and 20% of cases, respectively. CONCLUSION: The results demonstrate that the DLBAS algorithm provides reproducible VOI predictions for radiomics feature extraction. Variability remains regarding direct clinical applicability of predictions for RT treatment planning.