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Bazzocchi A, Guglielmi G, Aparisi Gómez MP. Sarcoma Imaging Surveillance. Magn Reson Imaging Clin N Am 2023; 31:193-214. [PMID: 37019546 DOI: 10.1016/j.mric.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of solid tumors. There are many histologic subtypes. The prognosis after treatment may be estimated by the analysis of the type of tumor, grade, depth, size at diagnosis, and age of the patient. These type of sarcomas most commonly metastasize to the lungs and may have a relatively high rate of local recurrence, depending on the histologic type and surgical margins. Patients with recurrence have a poorer prognosis. The surveillance of patients with STS is therefore extremely important. This review analyzes the role of MR imaging and US in detecting local recurrence.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
| | - Giuseppe Guglielmi
- Department of Radiology, Hospital San Giovanni Rotondo, Italy; Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain
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Review of primary superficial soft tissue mesenchymal tumors of malignant or intermediate biological potential. Skeletal Radiol 2023; 52:435-445. [PMID: 35867123 DOI: 10.1007/s00256-022-04127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
The majority of the sarcomas are deep in location, larger than 5 cm in size, and heterogenous in imaging appearance. However, when sarcomas occur superficially, these typical features may be absent, failing to alert the radiologist to a malignancy and mimicking one of the more numerous benign superficial tumors that make up the bulk of soft tissue mass evaluations. This manuscript will discuss the current role of imaging in recognizing features concerning for superficial soft tissue sarcomas. Provided is an overview of the demographic, clinical, and imaging features of the most commonly encountered superficial soft tissue sarcomas, including undifferentiated pleomorphic, leiomyosarcoma, synovial sarcoma, liposarcoma, myxofibrosarcoma, dermatofibrosarcoma protuberans, epithelioid sarcoma, and angiosarcoma. A less common but primary superficial tumor, angiomatoid fibrous histiocytoma, is also reviewed as the diagnosis may be confounding both clinically and on imaging studies.
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Tumor-skin invasion is a reliable risk factor for poor prognosis in superficial soft tissue sarcomas. PLoS One 2022; 17:e0274077. [PMID: 36054224 PMCID: PMC9439222 DOI: 10.1371/journal.pone.0274077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Superficial soft tissue sarcomas are often left untreated unless they invade the skin and skin ulcers manifest. Progressive sarcomas frequently result in dismal oncological outcomes despite multidisciplinary treatment. This study aimed to identify prognostic factors for superficial soft tissue sarcomas. Materials and methods This study retrospectively analyzed the clinicopathological data of 82 patients with superficial soft tissue sarcomas treated between August 2003 and December 2020 at our institution. A superficial soft tissue sarcoma was defined if the percentage of the area occupied by the tumor in the assessed region (skin, subcutaneous) was more than 50%. Age, sex, location, tumor size, tumor-skin invasion, tumor grade, and distant metastasis at initial diagnosis were evaluated as potential prognostic factors. Cox proportional hazards regression models were used to identify the prognostic factors. Five-year survival rates were assessed by the Kaplan-Meier method. Results The mean follow-up time was 60.1 months. The 5-year overall survival, 5-year local recurrence-free survival, and 5-year metastasis survival rates were 76.4%, 60.6%, and 71.0%, respectively. Univariate analysis showed significant relationships between poor prognosis and tumor size ≥5 cm, distant metastasis at initial diagnosis, and tumor-skin invasion. In the multivariate analysis, only the tumor-skin invasion was associated with worse overall survival. Conclusions Superficial soft tissue sarcomas have biologically been considered a separate category due to their better prognosis. In this study, the tumor-skin invasion was the only significant factor associated with a poor prognosis. Therefore, all superficial soft tissue sarcomas without tumor-skin invasion should be treated as early as possible.
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Shu H, Ma Q, Li A, Wang P, Gao Y, Yao Q, Hu Y, Ye X. Diagnostic Performance of US and MRI in Predicting Malignancy of Soft Tissue Masses: Using a Scoring System. Front Oncol 2022; 12:853232. [PMID: 35574339 PMCID: PMC9104333 DOI: 10.3389/fonc.2022.853232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To assess the diagnostic performance of US and MRI in predicting malignancy of soft tissue masses by using a scoring system. Methods A total of 120 cases of pathologically confirmed soft tissue masses (71 cases of malignant lesions and 49 cases of benign lesions) were enrolled. All patients underwent ultrasound and MRI examination prior to biopsy or surgical excision. A scoring system based on the parameters of conventional US and MRI to distinguish malignant and benign masses was established by the regression model. The receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of US and MRI. Results Multivariate analysis showed that margin, maximum diameter, and vascular density were independent predictors for malignancy found by US, while maximum diameter, margin, and affected peripheral soft tissue were independent predictors for malignancy found by MRI. The mean scores of the benign and malignant groups were 2.8 ± 1.6, 5.1 ± 1.1 on US and 1.3 ± 1.2, 3.5 ± 0.9 on MRI. Based on the cut-off score of 3.5 and 2.5 calculated by ROC analysis, US and MRI had 92% and 87% sensitivity, 72% and 76% specificity, 86% and 89% accuracy, respectively. The combination of these two modalities achieved the sensitivity of 91%, specificity of 82%, and accuracy of 93%. Conclusions Both US and MRI can provide valuable information about the differential diagnosis between benign and malignant soft tissue masses. The combination of the two imaging-based scoring systems can increase the diagnostic performance, especially in specificity.
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Affiliation(s)
- Hua Shu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pingping Wang
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Yingqian Gao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiyu Yao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinhua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Jacobson JA, Middleton WD, Allison SJ, Dahiya N, Lee KS, Levine BD, Lucas DR, Murphey MD, Nazarian LN, Siegel GW, Wagner JM. Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2022; 304:18-30. [PMID: 35412355 DOI: 10.1148/radiol.211101] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists from radiology, orthopedic surgery, and pathology to arrive at a consensus regarding the management of superficial soft-tissue masses imaged with US. The recommendations in this statement are based on analysis of current literature and common practice strategies. This statement reviews and illustrates the US features of common superficial soft-tissue lesions that may manifest as a soft-tissue mass and suggests guidelines for subsequent management.
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Affiliation(s)
- Jon A Jacobson
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - William D Middleton
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Sandra J Allison
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Kenneth S Lee
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Benjamin D Levine
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - David R Lucas
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Mark D Murphey
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Levon N Nazarian
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Geoffrey W Siegel
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
| | - Jason M Wagner
- From the Departments of Radiology (J.A.J.), Pathology (D.R.L.), and Orthopaedic Surgery (G.W.S.), University of Michigan Medical Center, Ann Arbor, MI; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Radiology, Georgetown University School of Medicine, Washington, DC (S.J.A.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D.); Department of Radiology, University of Wisconsin, Madison, Wis (K.S.L.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (B.D.L.); Department of Radiology, American Institute of Radiologic Pathology, Silver Spring, Md (M.D.M.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (L.N.N.); Department of Radiology, University of Oklahoma, Oklahoma City, Okla (J.M.W.)
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Wu M, Hu Y, Hang J, Peng X, Mao C, Ye X, Li A. Qualitative and Quantitative Contrast-Enhanced Ultrasound Combined with Conventional Ultrasound for Predicting the Malignancy of Soft Tissue Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:237-247. [PMID: 34782165 DOI: 10.1016/j.ultrasmedbio.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Abstract
This study was aimed at evaluating the performance of perfusion patterns and the quantitative parameters of contrast-enhanced ultrasound (CEUS) in the detection of soft tissue tumors (STTs) and establishing a US workflow for STTs to improve patient management. Conventional ultrasound (US) and CEUS data were retrospectively collected from 156 soft tissue masses. Six perfusion patterns (P1-P6) were applied for CEUS qualitative analysis. Multivariate logistic regression was used to evaluate the performance of conventional US and qualitative and quantitative CEUS in distinguishing benign and malignant STTs. The malignancy rates of P1-P6 in STTs were 0%, 50.0%, 9.1%, 33.3%, 73.4% and 61.0%, respectively. For "non-P1" STTs, the predictive model combining quantitative CEUS parameters with conventional US features, including margin (odds ratio [OR] = 4.490, p = 0.000), vascular density (OR = 2.307, p = 0.013), 50% wash-out intensity (OR = 1.904, p = 0.032) and 50% wash-out time (OR = 1.031, p = 0.019), performed favorably in predicting malignancy, with an accuracy of 81.0% and an area under the receiver operating characteristic curve of 0.868. Furthermore, a US workflow for the detection of STTs based on conventional US and CEUS was established. CEUS with qualitative and quantitative analyses could be an effective tool for STT diagnosis. The US workflow in this study may improve the management of STT patients.
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Affiliation(s)
- Mengjie Wu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Hu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Hang
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojing Peng
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cuilian Mao
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinhua Ye
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ao Li
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Saifuddin A, Ali S, Sabahuddin A, Malhotra K, Khoo M. The differential diagnosis of trunk and extremity dermal and sub-dermal lesions referred to a musculoskeletal oncology service. Clin Imaging 2021; 78:51-59. [PMID: 33765643 DOI: 10.1016/j.clinimag.2021.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the differential diagnosis of dermal and sub-dermal soft tissue masses which do not extend to the deep fascia that are referred to a specialist musculoskeletal oncology service. MATERIALS AND METHODS Review of all patients referred to a specialist musculoskeletal oncology service over a 13-month period with a dermal or sub-dermal soft tissue mass which did not extend to the deep fascia based on MRI appearances. Data collected included age, gender, site and maximal lesion size, and final histological diagnosis for biopsied and/or excised lesions. RESULTS 56 patients were included, 21 (37.5%) males and 35 (62.5%) females with mean age 49.75 years (range 5-86 years). 3 patients had 2 lesions making a total of 59 lesions, 11 (18.6%) dermal and 48 (81.4%) sub-dermal. Histological diagnosis was available in 44 (74.6%) cases, of which 11 (25%) were non-neoplastic, 23 (52.3%) were benign neoplasms, and 10 (22.7%) were malignant neoplasms. Although older age at presentation and greater mean maximal tumour dimension were seen with malignant lesions, these did not reach statistical significance (p = 0.154 and 0.102 respectively). There was also no relationship between skin involvement from sub-dermal lesions and malignancy, but 5 of 6 dermal lesions which showed an exophytic growth pattern were malignant. CONCLUSIONS The differential diagnosis of dermal and sub-dermal lesions which do not reach the deep fascia is wide with a malignant lesion being the cause in almost one-quarter of cases.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sania Ali
- Department of Plastic Surgery, Wexham Park Hospital, UK
| | | | - Karan Malhotra
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK.
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Alramdan MHA, Kasalak Ö, Been LB, Suurmeijer AJH, Yakar D, Kwee TC. MRI after Whoops procedure: diagnostic value for residual sarcoma and predictive value for an incomplete second resection. Skeletal Radiol 2021; 50:2213-2220. [PMID: 33900432 PMCID: PMC8449770 DOI: 10.1007/s00256-021-03790-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of MRI for the detection and assessment of the anatomic extent of residual sarcoma after a Whoops procedure (unplanned sarcoma resection) and its utility for the prediction of an incomplete second resection. MATERIALS AND METHODS This study included consecutive patients who underwent a Whoops procedure, successively followed by gadolinium chelate-enhanced MRI and second surgery at a tertiary care sarcoma center. RESULTS Twenty-six patients were included, of whom 19 with residual tumor at the second surgery and 8 with an incomplete second resection (R1: n = 6 and R2: n = 2). Interobserver agreement for residual tumor at MRI after a Whoops procedure was perfect (κ value: 1.000). MRI achieved a sensitivity of 47.4% (9/19), a specificity of 100% (7/7), a positive predictive value of 100% (9/9), and a negative predictive value of 70.0% (7/17) for the detection of residual tumor. MRI correctly classified 2 of 19 residual sarcomas as deep-seated (i.e., extending beyond the superficial muscle fascia) but failed to correctly classify 3 of 19 residual sarcomas as deep-seated. There were no significant associations between MRI findings (presence of residual tumor, maximum tumor diameter, anatomic tumor extent, tumor margins, tumor spiculae, and tumor tail on the superficial fascia) with an incomplete (R1 or R2) second resection. CONCLUSION Gadolinium chelate-enhanced MRI is a reproducible method to rule in residual sarcoma, but it is insufficiently accurate to rule out and assess the anatomic extent or residual sarcoma after a Whoops procedure. Furthermore, MRI has no utility in predicting an incomplete second resection.
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Affiliation(s)
- Mohammed H. A. Alramdan
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Ömer Kasalak
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Lukas B. Been
- grid.4494.d0000 0000 9558 4598Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert J. H. Suurmeijer
- grid.4494.d0000 0000 9558 4598Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Derya Yakar
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Thomas C. Kwee
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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De Marchi A, Pozza S, Charrier L, Cannone F, Cavallo F, Linari A, Piana R, Geniò I, Balocco P, Massè A. Small Subcutaneous Soft Tissue Tumors (<5 cm) Can Be Sarcomas and Contrast-Enhanced Ultrasound (CEUS) Is Useful to Identify Potentially Malignant Masses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8868. [PMID: 33260631 PMCID: PMC7730454 DOI: 10.3390/ijerph17238868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
Subcutaneous masses smaller than 5 cm can be malignant, in contrast with the international guidelines. Ultrasound (US) and magnetic resonance imaging (MRI) are useful to distinguish a potentially malignant mass from the numerous benign soft tissue (ST) lesions. Contrast-enhanced ultrasound (CEUS) was applied in ST tumors, without distinguishing the subcutaneous from the deep lesions. We evaluated CEUS and MRI accuracy in comparison to histology in differentiating malignant from nonmalignant superficial ST masses, 50% smaller than 5 cm. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) with their 95% confidence intervals (CI) were calculated. Of malignant cases, 44.4% measured ≤5 cm. At univariate analysis, no statistically significant differences emerged between benign and malignant tumors in relation with clinical characteristics, except for relationship with the deep fascia (p = 0.048). MRI accuracy: sensitivity 52.8% (CI 37.0, 68.0), specificity 74.1% (CI 55.3, 86.8), PPV 73.1% (CI 53.9, 86.3), and NPV 54.1% (CI 38.4, 69.0). CEUS accuracy: sensitivity 75% (CI 58.9, 86.3), specificity 37% (CI 21.5, 55.8), PPV 61.4% (CI 46.6, 74.3), and NPV 52.6% (CI 31.7, 72.7). CEUS showed a sensitivity higher than MRI, whereas PPV and NPV were comparable. Also, masses measuring less than 5 cm can be malignant and referral criteria for centralization could be revised.
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Affiliation(s)
- Armanda De Marchi
- Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (A.D.M.); (S.P.); (P.B.)
| | - Simona Pozza
- Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (A.D.M.); (S.P.); (P.B.)
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5-bis, 10126 Torino, Italy;
| | - Filadelfo Cannone
- Radiology Department, Azienda Sanitaria Provinciale di Siracusa, E. Muscatello Hospital, Contrada Granatello, 96011 Augusta, Italy;
| | - Franco Cavallo
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5-bis, 10126 Torino, Italy;
| | - Alessandra Linari
- Department of Pathology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy;
| | - Raimondo Piana
- Department of Orthopaedic, Traumatology and Rehabilitation, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (R.P.); (A.M.)
| | - Irene Geniò
- Department of Imaging, Azienda Ospedaliero Universitaria G. Martino, Via Consolare Valeria 1, 98100 Messina, Italy;
| | - Paolo Balocco
- Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (A.D.M.); (S.P.); (P.B.)
| | - Alessandro Massè
- Department of Orthopaedic, Traumatology and Rehabilitation, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (R.P.); (A.M.)
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Banza MI, Tshiamala IB, Mukakala AK, Ngoie CN, Shutsha NT, Mukangala SI, Cabala VDPK, Tchankui MM, Kasanga TK, Kapessa ND. [Angiosarcoma of the shoulder revealed by previous trauma: about a case and literature review]. Pan Afr Med J 2020; 36:40. [PMID: 32774616 PMCID: PMC7388634 DOI: 10.11604/pamj.2020.36.40.20751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
L´angiosarcome est une tumeur rare à multiples localisations mais celle cutanée est la plus fréquente faisant de sa symptomatologie un polymorphisme clinique. C´est une tumeur de mauvais pronostic à cause de sa grande propension à la récidive locale et aux métastases à distances précoce. Nous rapportons un cas de découverte fortuite d´un angiosarcome de l´épaule sur un ancien foyer de traumatisme direct datant d´une année chez un patient de 72 ans, venu consulter pour douleur persistante en regard d´une tuméfaction à la face postérieure de l´épaule contemporaine au traumatisme. L´examen clinique conclu en un hématome ancien partiellement calcifié soutenu par la ponction de la masse ayant ramené 5 cc de sang d´aspect noirâtre et renforcé par une échographie. La radiographie de l´épaule n´étant pas pathologique, une exploration de la tuméfaction a été entreprise. Celle-ci a permis de mettre en évidence et reséquer des tissus friables, d´aspect rougeâtre, avec un saignement important difficilement maitrisé pendant deux jours compliqué d´une anémie non tolérée corrigée par deux transfusions sanguines. L´anatomie pathologique des tissus réséqués a conclu en un angiosarcome moyennement différentié avec malheureusement des berges non saines. Un bilan d´extension a été réalisé à la recherche des métastases. Pas de récidive locale sur trois mois et le patient a été transféré dans un centre spécialisé à Lusaka pour la radiothérapie complémentaire. L´objectif du présent travail est de présenter un cas rare d´angiosarcome de découverte fortuite sur un antécédent de traumatisme de l´épaule gauche et de ressortir les aspects thérapeutiques en passant en faisant une revue de la littérature.
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Affiliation(s)
- Manix Ilunga Banza
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Israël Badypwyla Tshiamala
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Augustin Kibonge Mukakala
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Christelle Ngoie Ngoie
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Néron Tapenge Shutsha
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Stéphane Ilunga Mukangala
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Vincent De Paul Kaoma Cabala
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Mireille Meuke Tchankui
- Service de Chirurgie de l´Hôpital Jason Sendwe, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Trésor Kibangula Kasanga
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie des Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Province du Haut-Katanga, Ville de Lubumbashi, République Démocratique du Congo
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Abstract
OPINION STATEMENT The proper diagnosis and treatment planning for subcutaneous soft tissue sarcoma is very important. Soft tissue tumors can occur anywhere in the body, but if they occur subcutaneously, patients can easily notice a subcutaneous soft tissue mass. Therefore, it is possible to determine through recording, the growth speed of the mass, which is often difficult to obtain with deep-situated soft tissue masses. Palpation can also provide information about the firmness and mobility of the mass. Thus, history taking and physical examinations are informative for subcutaneous soft tissue tumors, compared to tumors that occur deeply. Because subcutaneous soft tissue tumors are easily recognized, they are often resected, without sufficient imaging analyses or thorough treatment planning. An operation performed based on such an inadequate preoperative plan is called a "whoops surgery." In the case of "whoops surgeries," subsequent radical surgery is required to remove additional areas, including hematomas that result from the initial surgery, that require a wider range of resection and soft tissue reconstruction. Therefore, as with deep-seated soft tissue tumors, it is important to conduct careful imaging examinations and make appropriate preoperative plans for subcutaneous soft tissue tumors. Subcutaneous soft tissue sarcomas often show an invasive pattern, and such tumors require a more careful assessment to prevent local recurrence after surgery. During surgery, it is necessary to remove the entire infiltration area along the fascia. Sometimes, an adequately wide excision is necessary, which is considered the minimum necessary procedure to eradicate the lesion. As noted above, clinicians who see patients with subcutaneous soft tissue tumors are encouraged to have sufficient knowledge and experience regarding the diagnosis and treatment. This article is intended for all doctors who deal with subcutaneous soft tissue tumors and focuses on essential points regarding their diagnosis and management.
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Diagnostic value of tumor-fascia relationship in superficial soft tissue masses on magnetic resonance imaging. PLoS One 2018; 13:e0209642. [PMID: 30596710 PMCID: PMC6312209 DOI: 10.1371/journal.pone.0209642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/10/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose Many surgeons participate in the management of superficial soft tissue masses, and a preoperative incorrect diagnosis frequently results in dismal oncological outcomes. The aim of this study was to identify distinguishing magnetic resonance imaging features between malignant and non-malignant lesions. Methods The clinicopathological data for 219 patients (men 114; women 105) with superficial soft tissue masses treated from January 2007 to December 2016 in our institution were retrospectively analyzed. The median age at the first visit was 55.6 years (range 1–90 years). MRI findings of tumor size, margin, lobulation, intratumoral hemorrhage, peritumoral edema, and tumor-fascia relationship were compared with the final histological diagnosis and tumor grade. Results Univariate analysis revealed significant relationships between histologically malignant lesions and tumor size ≥5 cm (p = 0.035), positive peritumoral edema (p = 0.031), and tumor-fascia relationship (p<0.001), but not margin (p = 0.107), lobulation (p = 0.071), and intratumoral hemorrhage (p = 0.17). In addition, using multivariate analysis, the tumor-fascia relationship (p<0.001) and tumor size were significant factors. A significant correlation between tumor-fascia relationship and malignancy (p<0.001) was observed; such a relationship was, however, not observed for tumor grade (p = 0.43). Conclusions Tumors measuring ≥5 cm and the tumor-fascia relationship on magnetic resonance imaging are highly indicative of malignancy. When superficial soft tissue masses cross the superficial fascia and form obtuse angles with the fascia, sarcoma should be considered. The tumor-fascia relationship can offer surgeons useful information regarding the status of superficial soft tissue masses.
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Mulcahy H. Big Foot MRI: A Practical Guide for Radiologists to Soft Tissue Tumors and Tumor-Like Lesions of the Foot. Semin Roentgenol 2018; 54:162-176. [PMID: 31128739 DOI: 10.1053/j.ro.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kantilaras AP. Role of Ultrasound in the Diagnosis Approach of Malignant Solitary Fibrous Tumor. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318781779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a case study of solitary fibrous tumor (SFT), which is a rare neoplasm of mesenchymal origin that comprises less than 2% of all soft tissue tumors. SFT located in the extremities, especially in the legs, has a high possibility of developing malignancy. The case study presented demonstrates a sonogram which identified an inhomogenous hypoechoic solid lesion located in the subcutaneous layer of the femoral region. The use of Doppler showed hypervascular activity in the hyperechoic area. This finding was consistent with malignant SFT and confirmed by histopathologic exam. The possibility of an SFT should be a diagnostic consideration with any large soft tissue mass in extremities. This is a further consideration with the diagnostic medical sonography findings demonstrating a hypoechoic, well-defined mass that has a large collateral feeding vessel and displaces the adjacent structures.
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Moraux A, Bianchi S, Le Corroller T. Soft Tissue Masses of the Knee Related to a Focal Defect of the Lateral Patellar Retinaculum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1821-1825. [PMID: 29205448 DOI: 10.1002/jum.14508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
We report on the imaging features of 6 soft tissue masses in the anterolateral aspect of the knee related to a focal defect of the lateral patellar retinaculum. In 4 patients (3 female and 1 male; 6-65 years) presenting with nontender palpable soft tissue masses in the anterolateral aspect of their knees, ultrasonography showed a focal defect of the lateral patellar retinaculum with herniation of the Hoffa fat pad, which was only visible in flexion. A magnetic resonance imaging examination performed in 1 case confirmed the defect in the lateral patellar retinaculum but did not show a mass, as the knee was examined only at 10° of flexion. The 2 remaining patients (one male and 1 female; 62 and 55 years) presented with soft tissue masses in their anterolateral knees in both flexion and extension. These masses were related respectively to a lipoma of the Hoffa fat pad and to a ganglion cyst, both herniated through a defect of the lateral patellar retinaculum. Our cases suggest that a focal defect of the lateral patellar retinaculum may be a route for Hoffa fat pad herniation as well as a route for superficial extension of infrapatellar fat lesions such as lipomas and ganglion cysts.
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Affiliation(s)
- Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
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Kikuta K, Nakayama R, Yamaguchi S, Nishiwaki Y, Susa M, Nishimoto K, Horiuchi K, Nakamura M, Matsumoto M, Morioka H. Wide-spread ignorance on the treatment of subcutaneous malignant tumors; a questionnaire-based study. Jpn J Clin Oncol 2018; 48:130-134. [PMID: 29294111 DOI: 10.1093/jjco/hyx184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/13/2017] [Indexed: 12/24/2022] Open
Abstract
Background Subcutaneous malignant tumors are often treated by non-specialized clinicians in musculoskeletal oncology. While the resection of subcutaneous tumors appears technically feasible, unplanned resection of malignant tumors can result in a devastating clinical outcome. The aim of this study was to evaluate the potential estrangement in the awareness of and the treatment strategy for the patients with subcutaneous soft tissue tumors between musculoskeletal oncologists and non-specialized clinicians. Methods A questionnaire probing the clinical assessment of subcutaneous tumors was sent to orthopedic surgeons, dermatologists, plastic surgeons, and general surgeons. Results of the questionnaire were statistically analyzed. Results One hundred sixteen clinicians out of 150 responded to the questionnaire; the response rate was 77.3%. Among those, 46 clinicians had treated subcutaneous tumors. Thirty-nine of these 46 clinicians (27 musculoskeletal oncologists and 12 non-specialized clinicians) preoperatively performed enhanced MRI for diagnostic evaluation. Preoperative incisional biopsy to confirm the pathological diagnosis was performed by 36 of the 46 clinicians (29 musculoskeletal oncologists and seven non-specialized clinicians). These results indicate that musculoskeletal oncologists perform preoperative enhanced MRI (P = 0.08) and biopsy (P < 0.01) more frequently than non-specialized clinicians. The recognition rate of 'myxofibrosarcoma' was 60.8% among clinicians with an experience with sarcoma treatment (25 musculoskeletal oncologists and three non-specialized clinicians). The recognition rate of 'myxofibrosarcoma' between musculoskeletal oncologists and non-specialized clinicians was statistically significant (P < 0.01). Conclusions Preoperative evaluations for subcutaneous tumors are more often inappropriate in non-specialized clinicians than those who are. Therefore, it will be mandatory to raise the awareness of this condition to improve the clinical outcome of patients with subcutaneous tumors.
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Affiliation(s)
- Kazutaka Kikuta
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Sayaka Yamaguchi
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Yuuji Nishiwaki
- Division of Environmental and Occupational Health, Department of Social Medicine, Faculty of Medicine, Toho University, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | | | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine
| | - Hideo Morioka
- Department of Orthopaedic Surgery, Keio University School of Medicine
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18
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Abstract
Superficial solid masses are common conditions in clinical practice, however, some of which can be easily diagnosed and others would be difficult. Although imaging of superficial masses is not always characteristic, it would be helpful to give a definitive diagnosis or narrow a differential diagnosis. Crossing-section imaging can depicture the masses directly, find some pathognomonic signs and demonstrate their relationship with adjacent structures, which can provide decision support for clinician's reference. Computed tomography (CT) can be used to detect calcifications and bone erosion which could not be seen on radiographs. Magnetic resonance imaging (MRI) is the preferred way for evaluating soft tissue lesions and provides information on hemorrhage, necrosis, edema, cystic and myxoid degeneration, and fibrosis. Other advantages of MRI are its superior soft tissue resolution and any profile imaging, which can aid the assessment of extension and adjacent infiltration. Positron emission tomography (PET)/CT and PET/MRI have been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. Therefore, imaging examination can play an important role in treatment decision making for superficial solid tumors. Here we review the important conditions presenting as superficial mass and show the imaging of typical cases diagnosed in our hospital.
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yanyuan Li
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yilei Zhao
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianjun Qiao
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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Manenti G, Cavallo AU, Marsico S, Citraro D, Vasili E, Lacchè A, Forcina M, Ferlosio A, Rossi P, Floris R. Chronic expanding hematoma of the left flank mimicking a soft-tissue neoplasm. Radiol Case Rep 2017; 12:801-806. [PMID: 29484075 PMCID: PMC5823383 DOI: 10.1016/j.radcr.2017.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/15/2017] [Accepted: 07/27/2017] [Indexed: 12/28/2022] Open
Abstract
Soft-tissue hematomas are a common clinical entity often associated with trauma, surgery, and bleeding disorders. In the majority of cases, soft-tissue hematomas acutely appear and spontaneously resolve, but sometimes, they present as swellings that slowly expand and progressively increase with time. We present a case of a 70-year-old man with chronic expanding hematoma of the left flank without any history of recent trauma or other medical disease. The diagnosis could not be confirmed on imaging features alone, so the patient was taken to surgery for open biopsy and excision. In patients with slowly growing extremity masses without recent trauma or chronic medical disorders, the differential diagnosis becomes challenging, and chronic expanding hematoma should be considered in addition to soft-tissue sarcomas and other malignancies.
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Affiliation(s)
- Guglielmo Manenti
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Armando Ugo Cavallo
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Salvatore Marsico
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Daniele Citraro
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Erald Vasili
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Adriano Lacchè
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Marco Forcina
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology Institute, Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Piero Rossi
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Roberto Floris
- Department of Diagnostic Radiology, Molecular Imaging, Radiation Therapy and Interventional Radiology, University of Rome "Tor Vergata," Viale Oxford, 81, 00133 Rome, Italy
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Chuanping G, Weiwei F. Recurrent, giant subcutaneous leiomyosarcoma of the thigh. Radiol Case Rep 2015; 10:18-21. [PMID: 26649111 PMCID: PMC4633980 DOI: 10.1016/j.radcr.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/11/2015] [Indexed: 11/30/2022] Open
Abstract
We present a case of recurrent, massive subcutaneous leiomyosarcoma involving the left thigh in a 29-year-old male from Madagascar. The patient had earlier undergone local resection of subcutaneous leiomyosarcoma a half year before. After surgical intervention, local recurrence developed at this site and was rapidly growing. The patient was surgically treated with a 2-cm-wide margin local excision in our hospital. The patient has remained recurrence free at 1-year follow-up.
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Chinyengetere F, Sekula DJ, Lu Y, Giustini AJ, Sanglikar A, Kawakami M, Ma T, Burkett SS, Eisenberg BL, Wells WA, Hoopes PJ, Demicco EG, Lazar AJ, Torres KE, Memoli V, Freemantle SJ, Dmitrovsky E. Mice null for the deubiquitinase USP18 spontaneously develop leiomyosarcomas. BMC Cancer 2015; 15:886. [PMID: 26555296 PMCID: PMC4640382 DOI: 10.1186/s12885-015-1883-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background USP18 (ubiquitin-specific protease 18) removes ubiquitin-like modifier interferon stimulated gene 15 (ISG15) from conjugated proteins. USP18 null mice in a FVB/N background develop tumors as early as 2 months of age. These tumors are leiomyosarcomas and thus represent a new murine model for this disease. Methods Heterozygous USP18 +/− FVB/N mice were bred to generate wild-type, heterozygous and homozygous cohorts. Tumors were characterized immunohistochemically and two cell lines were derived from independent tumors. Cell lines were karyotyped and their responses to restoration of USP18 activity assessed. Drug testing and tumorigenic assays were also performed. USP18 immunohistochemical staining in a large series of human leiomyosacomas was examined. Results USP18 −/− FVB/N mice spontaneously develop tumors predominantly on the back of the neck with most tumors evident between 6–12 months (80 % penetrance). Immunohistochemical characterization of the tumors confirmed they were leiomyosarcomas, which originate from smooth muscle. Restoration of USP18 activity in sarcoma-derived cell lines did not reduce anchorage dependent or independent growth or xenograft tumor formation demonstrating that these cells no longer require USP18 suppression for tumorigenesis. Karyotyping revealed that both tumor-derived cell lines were aneuploid with extra copies of chromosomes 3 and 15. Chromosome 15 contains the Myc locus and MYC is also amplified in human leiomyosarcomas. MYC protein levels were elevated in both murine leiomyosarcoma cell lines. Stabilized P53 protein was detected in a subset of these murine tumors, another feature of human leiomyosarcomas. Immunohistochemical analyses of USP18 in human leiomyosarcomas revealed a range of staining intensities with the highest USP18 expression in normal vascular smooth muscle. USP18 tissue array analysis of primary leiomyosarcomas from 89 patients with a clinical database revealed cases with reduced USP18 levels had a significantly decreased time to metastasis (P = 0.0441). Conclusions USP18 null mice develop leiomyosarcoma recapitulating key features of clinical leiomyosarcomas and patients with reduced-USP18 tumor levels have an unfavorable outcome. USP18 null mice and the derived cell lines represent clinically-relevant models of leiomyosarcoma and can provide insights into both leiomyosarcoma biology and therapy. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1883-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fadzai Chinyengetere
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - David J Sekula
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Yun Lu
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Andrew J Giustini
- Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. .,Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
| | | | - Masanori Kawakami
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Tian Ma
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Sandra S Burkett
- Comparative Molecular Cytogenetics Core, Mouse Cancer Genetics Program, National Cancer Institute, Frederick, MD, USA.
| | - Burton L Eisenberg
- Department of Surgery, Dartmouth, Hanover, NH, USA. .,Norris Cotton Cancer Center, Lebanon, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Wendy A Wells
- Department of Pathology, Dartmouth, Hanover, NH, USA. .,Norris Cotton Cancer Center, Lebanon, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Paul J Hoopes
- Department of Surgery, Dartmouth, Hanover, NH, USA. .,Norris Cotton Cancer Center, Lebanon, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. .,Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
| | | | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Sarcoma Research Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Keila E Torres
- Sarcoma Research Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Vincent Memoli
- Department of Pathology, Dartmouth, Hanover, NH, USA. .,Norris Cotton Cancer Center, Lebanon, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Sarah J Freemantle
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Ethan Dmitrovsky
- Department of Pharmacology and Toxicology, Dartmouth, Hanover, NH, USA. .,Department of Medicine, Dartmouth, Hanover, NH, USA. .,Norris Cotton Cancer Center, Lebanon, NH, USA. .,Geisel School of Medicine, Dartmouth, Hanover, NH, USA. .,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. .,Present address: MD Anderson Cancer Center, Houston, TX, 77030-4009, USA.
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22
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Abstract
Certain soft-tissue tumors seem to be specific to the upper extremity; most are benign. Knowledge of key magnetic resonance features, with clinical history and epidemiologic knowledge, can assist the radiologist in establishing optimal diagnosis. Indeterminate lesions require biopsy to exclude malignancy.
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Affiliation(s)
- Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
| | - Hiroshi Nishimura
- Department of Radiology, Saiseikai Futsukaichi Hospital, 3-13-1 Yu-machi, Chikushino, Fukuoka 818-0058, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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23
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Chung HW, Cho KH. Ultrasonography of soft tissue "oops lesions". Ultrasonography 2015; 34:217-25. [PMID: 25868733 PMCID: PMC4484290 DOI: 10.14366/usg.14068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/30/2022] Open
Abstract
In this article, I would like to define “oops lesions” as soft tissue mass-like lesions that involve surprise or embarrassment for radiologists following the final diagnosis. Examples of “oops lesions” include malignant tumors that appear benign, malignancy-mimicking benign tumors, incorrect identification of epidermal inclusion cysts, and soft tissue pseudotumors. Ultrasonography (US) findings are very helpful in the diagnosis of soft tissue tumors; however, the diagnosis of soft tissue tumors on the basis of US findings alone has some limitations. Therefore, clinical findings, laboratory data, findings from additional imaging modalities, and demographic data of patients should be considered together with US findings.
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Affiliation(s)
- Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kil-Ho Cho
- Department of Radiology, Yeungnam University College of Medicine, Daegu, Korea
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24
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Hammas N, Badioui I, Znati K, Benlemlih A, Chbani L, El Fatemi H, Harmouch T, Bouyahyaoui Y, Boutayeb F, Mrini A, Mesbahi O, Mernissi FZ, Amarti A. [Dermatofibrosarcoma protuberans : report of 27 cases and review of the literature]. Pan Afr Med J 2014; 18:280. [PMID: 25489374 PMCID: PMC4258206 DOI: 10.11604/pamj.2014.18.280.1087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 06/25/2012] [Indexed: 11/18/2022] Open
Abstract
Le dermatofibrosarcome de Darier et Ferrand (DFS) est une tumeur mésenchymateuse cutanée de malignité intermédiaire. C'est une tumeur rare mais non exceptionnelle, représentant 0,1% des tumeurs cutanées malignes. Les auteurs présentent une étude rétrospective de 27 cas de DFS diagnostiqués sur une durée de 7 ans (2004 à 2010) et la comparent aux données de la littérature. Cette étude permet d’établir en plus des caractéristiques anatomopathologiques et immunohistochimiques, une étude épidémiologique, clinique et évolutive de ce sarcome. l’âge moyen de nos patients est de 41 ans avec une prédominance masculine. Le tronc est la localisation préférentielle touché dans 52% des cas. La taille tumorale a atteint 30cm et mesure en moyenne 6,1 cm. Le diagnostic était évoqué à l'examen histologique standard et confirmé par l'expression intense et diffuse du CD34. Le traitement était chirurgical, associé à une radiothérapie dans 2 cas. L’évolution était marquée par la transformation en un sarcome pléomorphe de haut grade dans un cas et par la survenue de récidives locales dans 2 cas. Nos résultats sont classiques et comparables aux autres séries de la littérature. L'examen histologique est indispensable pour le diagnostic. L'exérèse chirurgicale large est le traitement de référence. Le pronostic est conditionné par une malignité surtout locale et un fort potentiel de récidive. La transformation sarcomateuse franchement maligne métastasiante est exceptionnelle.
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Affiliation(s)
- Nawal Hammas
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
| | - Ikram Badioui
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
| | - Kaoutar Znati
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
| | - Amal Benlemlih
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
| | - Laila Chbani
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
| | - Hind El Fatemi
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
| | | | | | - Faouzi Boutayeb
- Service de traumatologie-orthopédie, CHU Hassan II, Fès, Maroc
| | | | | | | | - Afaf Amarti
- Service d'anatomie pathologique, CHU Hassan II, Fès, Maroc
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25
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Lee JJ, Bredella MA, Springfield DS, Nielsen GP. Soft tissue angiofibroma: a case report. Skeletal Radiol 2014; 43:403-7. [PMID: 24113908 DOI: 10.1007/s00256-013-1742-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 02/06/2023]
Abstract
Soft tissue angiofibroma is a recently described neoplasm that typically presents as a slowly growing, painless mass in the soft tissues of the lower extremities. Cytogenetic and molecular studies have identified a recurrent t(5;8) translocation. Treatment is simple excision. Existing data suggest that this tumor is benign and has a low rate of local recurrence. The radiologic and pathologic differential diagnoses for this lesion include both benign and malignant lesions, including plantar fibromatosis, tenosynovial giant cell tumor, fibroma of tendon sheath, epithelioid sarcoma, and low-grade myxofibrosarcoma. Proper identification of this benign lesion through radiologic and pathologic correlation is important to prevent misdiagnosis of a low-grade sarcoma.
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Affiliation(s)
- Jonathan J Lee
- Harvard Medical School, 250 Longwood Avenue, Boston, MA, 02115, USA,
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26
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Safini F, Naim A, Bouchbika Z, Benchakroun N, Jouhadi H, Tawfiq N, Sahraoui S, Benider A. [Stewart-Treves syndrome complicating chronic idiopathic lymphedema]. Pan Afr Med J 2014; 19:311. [PMID: 25883738 PMCID: PMC4393999 DOI: 10.11604/pamj.2014.19.311.5636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/01/2014] [Indexed: 11/11/2022] Open
Abstract
Le syndrome de Stewart-Treves (SST) est une entité rare, correspondant à un angiosarcome cutané compliquant un lymphoedème chronique. Il est de mauvais pronostic. Stewart et Treves ont rapportés en 1948, les premiers cas d'angiosarcome secondaire à un traitement du cancer du sein. Ce terme s'est généralisé pour regrouper l'ensemble des cas de lymphangiosarcome sur lymphoedème d'origine congénital héréditaire ou non héréditaire, post-traumatique ou post-infectieux. Le SST sur un lymphoedème idiopathique reste exceptionnel. Nous rapportons le cas rare d'une patiente présentant un lymphoedème chronique primitif idiopathique des quatre membres évoluant depuis l'adolescence et qui a développé un SST du membre supérieur droit. Elle a subi une amputation à mi- bras vu le caractère très évolué de la tumeur
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Affiliation(s)
- Fatima Safini
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Asmaa Naim
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Zineb Bouchbika
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Nadia Benchakroun
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Hassan Jouhadi
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Nezha Tawfiq
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Souha Sahraoui
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
| | - Abdellatif Benider
- Service de Radiothérapie-Oncologie, Centre hospitalier Ibn Rochd, Casablanca 1, quartier des hôpitaux 20360, Casablanca, Maroc
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27
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Abstract
Superficial leiomyosarcomas are rare malignant smooth-muscle tumors accounting for 4-6.5% of all soft-tissue sarcomas, less than 2-3% of cutaneous soft-tissue neoplasms and 0.04% of all cancers. They are divided into cutaneous or dermal and subcutaneous leiomyosarcomas. Subcutaneous tumors have been reported to be associated with an increased risk of local recurrences and distant metastases, compared to their cutaneous counterparts. In this study, we describe a rare case of a recurrent subcutaneous trunk leiomyosarcoma in a 68-year-old male patient. Local recurrence developed two years after the complete surgical resection with wide margins and adjuvant postoperative radiotherapy. The management of the patient is discussed along with a review of the literature. We conclude that subcutaneous leiomyosarcoma is a rare clinical entity which may be associated with an atypical clinical presentation. Physicians should be aware of the misleading features of this tumor in order to avoid delay in diagnosis and treatment. Early complete surgical resection with wide margins of at least 2 cm is the cornerstone of treatment and has been reported to mostly influence the prognosis. However, the tumor has a high tendency to recur locally and metastasize. Recurrence may develop despite wide resection and radiotherapy. Long-term follow-up is mandatory.
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28
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Radiology-pathology conference: cutaneous angiosarcoma of the leg. Clin Imaging 2013; 37:602-7. [PMID: 23601777 DOI: 10.1016/j.clinimag.2012.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 08/01/2012] [Indexed: 11/23/2022]
Abstract
Cutaneous angiosarcoma is a rare aggressive vascular neoplasm with a poor prognosis, seen usually in the elderly population in a background of chronic lymphedema. We present a case of cutaneous angiosarcoma of the leg without any chronic lymphedema with clinicoradiological and histological correlation.
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29
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Calleja M, Dimigen M, Saifuddin A. MRI of superficial soft tissue masses: analysis of features useful in distinguishing between benign and malignant lesions. Skeletal Radiol 2012; 41:1517-24. [PMID: 22491777 DOI: 10.1007/s00256-012-1385-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/27/2011] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
AIM To identify the MRI features of superficial soft tissue masses, that may allow differentiation between malignant and non-malignant lesions. METHOD A total of 136 consecutive patients referred to a supra-regional musculoskeletal oncology center over a 10-year period with the diagnosis of a superficial soft tissue mass were included in this retrospective study. Features analyzed included patient demographics, lesion size, MRI signal characteristics, margins, lobulation, hemorrhage, necrosis, fascial edema, relationship to the fascia, as well as involvement of the skin. Comparison was then made with the final histological diagnosis. RESULTS Of the patients reviewed, 58 were male and 78 were female, and the mean age was 49.9 years. The mean age for malignant lesions was 57.9 years, and that for non-neoplastic and benign conditions 41.9 years (p < 0.001). A significant relationship was identified between malignancy and lobulation (p < 0.01), hemorrhage (p < 0.001), fascial edema (p < 0.001), hemorrhage (p < 0.0001) and necrosis (p < 0.001). The relationship between skin thickening and skin contact and malignancy was also found to be significant. However, size was not found to be an important determining factor for malignancy, with a significant proportion of malignant superficial sarcomas measuring less than 5 cm in maximal diameter. CONCLUSIONS This study has shown that a significant proportion of malignant superficial sarcomas measured less than 5 cm in maximal diameter. Fascial edema, skin thickening, skin contact, hemorrhage, and necrosis were found to be highly significant factors indicative of malignancy. Lobulation and peritumoral edema were also significant MRI features.
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