Vol 14 ppt


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Vol 14 ppt

  1. 1. Volume 14 Fibrous Soft Tissue TumorsDesmoid tumors---------------------Case 250-253 & 1170-1Aponeuratic fibroma----------------Case 1172-1173Infantile fibromatosis---------------Case 254Elastofibroma------------------------Case 255Nodular fascitis----------------------Case 256Plantar fibroma-----------------------Case 257Malignant fibrous histiocytoma----Case 258-265 &1174-75Low grade fibromyxoid sarcoma---Case 1178Fibrosarcoma--------------------------Case 266-7 & 1179-1181Dermatofibrosarcoma protuberans-Case 268-269Leiomyosarcoma----------------------Case 1182
  2. 2. Desmoid Tumors
  3. 3. Desmoid Tumor One of the most common benign soft tissue tumors is the extra-abdominal desmoid tumor, sometimes referred to as an aggressivefibromatosis or simple desmoid tumor. As compared to the multitudeof different clinical types of infantile fibromatosis, the desmoidtumor occurs in older children or young adults up through the ageof 40 years. The abdominal desmoid tumor is usually seen in youngadult females following pregnancy, whereas the extra-abdominaldesmoid tumor is found more commonly in men, usually in theproximal parts of the body such as the shoulder, buttock and posteriorthigh area. Other areas include the popliteal space, the arm andforearm. They are usually solitary lesions, however multi-centricinvolvement can occur. In the case of “Gardner’s syndrome” thedesmoid tumor can be associated with polyposis of the large boweland cranial-facial osteomas. Desmoid tumors take their origin frommuscle fascial planes and tend to be extensively infiltrative into thesurrounding tissue with poorly defined margins that make surgical
  4. 4. resection difficult. They can also occur in tendon sheaths, jointcapsules, and even inside bone. Clinically, the desmoid tumor hasthe appearance of a low grade fibrosarcoma but tends to be moreinvasive in character and can frequently engulf adjacent neuro-vascular structures. Even though the desmoid tumor has a histo-logical appearance similar to a low grade fibrosarcoma, it willnever metastasize to distant parts but can be multifocal in itspresentation in the extremity. Clinically, the desmoid tumor isvery firm to palpation. It frequently causes symptoms of pain andis tender on deep palpation. Microscopically the tumor is heavilycollagenized but with a very low mitotic index, with an appearancesimilar to plantar fibromatosis. The desmoid tumor does not calcify but is radiodense on ordinaryradiographs and can be easily identified on a soft tissue window CTscan. The MRI is the best imaging study for this tumor and will below signal on the T-1 weighted image but only intermediate highsignal on the T-2 because of the low water content in this tumor
  5. 5. which helps separate it from malignant MFH and fibrosarcoma.The desmoid tumor is related to physical activity compared tohigher grade spindle cell tumors that are more spontaneous in origin. Treatment consists of a wide surgical resection, if possible, butbecause of the high recurrence rate (about 50%), most clinicianswill advise post operative radiation therapy to the extent of 5000centigray to the surgical site starting two weeks after surgery. Thisreduces the chance of local recurrence to 10-15%. In rare situationswhere the patient has multiple recurrences locally following RT,amputation may be indicated. Even with amputation, recurrenceswill be seen at the amputation site. In patients over 40 years of ageit is not unusual to see a spontaneous involution of desmoid tumorsrequiring no treatment whatsoever. Estrogen may play a role in thedevelopment of desmoid tumors and this accounts for the use oftamoxifen with some reported clinical benefit. Other adjuvanttherapies include nonsteroidal anti-inflammatory agents and eventhe use of mild chemotherapeutic agents.
  6. 6. CLASSIC Case #250.1 Axial T-1 MRI 50 year male with desmoid tumor thigh
  7. 7. Coronal T-2 MRI
  8. 8. Axial T-2 MRI
  9. 9. Axial gad contrast MRI
  10. 10. Resection specimen cut in path lab
  11. 11. Photomic
  12. 12. Higher power
  13. 13. Case #250.2 Coronal T-1 MRI 45 year female with desmoid tumor gluteus maximus
  14. 14. Axial T-1 MRI
  15. 15. Axial T-2 MRI
  16. 16. Resection specimen cut in path lab
  17. 17. Photomic
  18. 18. Case #250.3 Coronal T-1 MRI 61 year male with desmoid gluteus maximus
  19. 19. Sagittal T-2 MRI
  20. 20. Case #250.3 Sag T-2 Sag Gad15 year female with painful enlarging desmoid past 6 months while on chemotherapy
  21. 21. Coronal Gad shows minimal response to chemotherapy
  22. 22. Axial T-2 vesselsAxial Gad
  23. 23. Cor T-2 Two Cor gad Sag gad2 yrs later with recurrence above and below the RT ports
  24. 24. Prox thigh axial T-2 GadDistal thigh in areaof previous surgery and 5000 rads RT
  25. 25. Case #250.461 year maleaxillary desmoid
  26. 26. Coronal T-1 MRI
  27. 27. Coronal T-2 MRI
  28. 28. Case #250.5 2007 Cor T-2 Gad Axial Gad 21 year male with tender mass in axilla for 6 months
  29. 29. 2009Cor T-2 Gad Axial Gad Post low dose chemotherapy
  30. 30. Case #251 11 year male with desmoid foot
  31. 31. Sagittal T-1 MRI
  32. 32. Axial T-1 MRI
  33. 33. Axial T-2 MRI
  34. 34. Resected specimen with wedge cut out
  35. 35. Case #251.1 Desmoid tumor of foot10 year male with firm tender swelling in forefoot 18 mos following a pellet gun injury to foot
  36. 36. Cor T-1 T-2 Gad
  37. 37. Sag T-1 Gad
  38. 38. Axial T-1 T-2Gad
  39. 39. Case #25211 year maledesmoid posteriorcompartment thighCoronal T-1 MRI
  40. 40. Coronal T-2 MRI
  41. 41. Axial T-2 MRI
  42. 42. Case #25329 year malerecent fracture ulna
  43. 43. 18 months laterwith desmoid tumorat fracture site
  44. 44. Sagittal T-2 MRI 18 months later with desmoid tumor
  45. 45. Axial T-2 MRI at 18 months
  46. 46. Photomic
  47. 47. Post op resectiondistal ulna withsynostosis of distalulnar tip to radius
  48. 48. Case #253.1 Sagittal T-1 MRI 14 year male with desmoid tumor hand 2 years
  49. 49. Sagittal T-2 MRI
  50. 50. Axial T-1 MRI
  51. 51. Axial T-2 MRI
  52. 52. Case #253.2 Desmoid tumor56 yr male with tender soft tissue mass volar aspect of wrist 6 mos
  53. 53. Cor T-1 T-2 Gad
  54. 54. Axial T-1 T-2 Gad
  55. 55. Case #1170 Axial T-1 MRI 45 year female with desmoid tumor post capsule knee
  56. 56. Sagittal T-2 MRI
  57. 57. Coronal T-2 MRI
  58. 58. Coronal STIR MRI
  59. 59. Surgical specimen cut in path lab
  60. 60. Photomic
  61. 61. Case #1170.1 P.O. desmoid 61 year female with OA knee in 3/06 prior to TKA
  62. 62. Sag MRI 4/03T-1 T-2
  63. 63. MRI 1 year PO TKASag T-2 Gad
  64. 64. AxialT-1 T-2 Gad
  65. 65. Surgical resection
  66. 66. Case #1170.2 Axial T-1 T-2 P.O. desmoid82 yr female who noted aslow growing tender massat the site of a prior cervicallaminectomy Gad
  67. 67. Sag T-1 T-2 Gad
  68. 68. Case #1171 9 year male with desmoid tumor posterior axilla
  69. 69. tumorCT scan
  70. 70. tumorAxial T-2 MRI
  71. 71. Photomic
  72. 72. Aponeuratic Fibroma
  73. 73. Case #1172 6 year male with aponeuratic fibroma middle finger
  74. 74. Photomic showing punctate calcific chondroid tissue
  75. 75. Another photomic with punctate calcification
  76. 76. Case #1173 21 year male with aponeuratic fibroma index finger
  77. 77. Surgical specimen showing calcium deposits
  78. 78. Photomic showing chondroid calcification
  79. 79. InfantileFibromatosis
  80. 80. CLASSIC Case #254 2 month male with infantile fibromatosis right leg
  81. 81. AP LATDysplastic bowing fibula at age 2 years
  82. 82. Progressive changes at 7 years
  83. 83. Sagittal T-1 MRI at 7 years
  84. 84. Sagittal T-2 MRI age 7
  85. 85. Elastofibroma
  86. 86. Elastofibroma The elastofibroma is seen almost exclusively in people past theage of 55 years. It is more common in women than men, and themajority of cases are seen in those involved in heavy manual laboror unusual sports requiring extensive use of the upper extremities.It almost always occurs between the scapula and the chest wallinferiorly and is bilateral in about 10% of cases. It is usually locatedin the lower subscapular area, deep to the rhomboid and latissimusdorsi muscles where it is firmly attached to the chest wall in the areaof the seventh and eighth ribs posteriorly. Grossly, the tumor has anappearance similar to a desmoid tumor and microscopically there isan intertwining of swollen eosinophillic collagen fibers and elasticfibers in an equal proportion. The elastic fibers have a degenerated,beaded appearance or are fragmented into small globules or dropletsthat are easily seen with the Verhoeff stain that is specific for elastinfiber. The cross section shows a characteristic serrated edge. The
  87. 87. elastofibroma is considered a reactive pseudotumor with an excellentprognosis. It is treated by a marginal surgical resection with anextremely low recurrence rate and in some cases can be treated byradiation therapy alone without surgery.
  88. 88. CLASSIC Case #255 Axial T-1 MRI 50 female with subscapular elastofibroma
  89. 89. Axial T-2 MRI
  90. 90. Resected surgical specimen
  91. 91. Photomic showing elastic fibers
  92. 92. Elastic fibers seen with Verhoeff elastin stain
  93. 93. Case #255.1 Axial T-135 yr female withslightly tender lumpbelow tip of scapula T-2for 1 yr Gad
  94. 94. Cor T-1 T-2 Gad
  95. 95. Case #255.2 Axial CT scan Coronal70 yr female with a slightly tendersoft mass beneath tip of rightscapula for 1 yr Elastofibroma
  96. 96. Nodular Fascitis
  97. 97. Nodular Fascitis Nodular fascitis is a very common, self-limiting, reactive processrather than a true neoplasm occurring in young adults. Typically itarises spontaneously and rapidly in the subcutaneous portion of thelower aspect of the forearm and is associated with inflammatorypain, swelling and local tenderness. Histologically, nodular fascitiscan take on the appearance of a spindle cell sarcoma. The lesiongrows quite rapidly over a period of several weeks, is usuallysolitary, and usually occurs in the upper extremity. It is usually lessthan 3 cm in diameter, has a grayish-white appearance and can havemyxoid changes. Histologically, the lesion is a fibroblastic pseudo-tumor similar to granulation tissue with a fair number of mitoticfigures but no atypical mitoses will be seen. The fibroblasts areinfiltrated by lymphocytes. Treatment consists of local surgicalexcision with a rare recurrence rate of less than 2%. No adjuvanttherapy is indicated.
  98. 98. CLASSIC Case #256 25 year female with nodular fascitis forearm
  99. 99. Surgical resection
  100. 100. Surgical specimen
  101. 101. Photomic
  102. 102. Plantar Fibroma
  103. 103. Plantar Fibroma The plantar fibroma is a fairly common clinical entity similar toto the palmar fibroma. It arises from the plantar fascia and is usuallylocated on the medial portion of the arch of the foot. As opposed topalmar fibromatosis that is typically seen in older patients, the plantarfibroma is more common in young adults or even in children. Insome cases, there is a familial background (this is particularly truein Scandinavians), with a greater incidence in males. The plantarfibroma is frequently asymptomatic in which case surgical treatmentis not indicated. However, if pain results, especially if pressure on anadjacent central nerve causes symptoms, a simple surgical resectioncan be performed. Both the palmar and plantar fibromas have acharacteristic fibrotic histological appearance that is quite cellularin areas and can be misdiagnosed as a malignant sarcoma. Somepatients will have fibromas in their hands and feet simultaneouslyand can also have penile fibromas. A contracture of the finger istypical in palmar fibromas whereas toe contractures are not seen inplantar fibromatosis.
  104. 104. CLASSIC Case #257 32 year female with plantar fibroma
  105. 105. Photomic
  106. 106. Higher power
  107. 107. Case #257.1 Sag T-148 year male withrecurrent lump onplantar aspect of footrecurrent from surgery17 years ago T-2 Gad
  108. 108. Axial T-1 T-2 Gad
  109. 109. Malignant Fibrous Histiocytoma
  110. 110. Malignant Fibrous Histiocytoma The malignant fibrous histiocytoma (MFH) is the most commonhigh grade soft tissue tumor. It occurs typically in older patients pastthe age of 50 years and is more common in men. The most commontype is the so-called storiform or pleomorphic malignant fibroushistiocytoma, followed next by the myxoid, giant cell, and inflamma-tory subtypes. The pleomorphic form is seen in patients between thethe age of 50 and 70 years, and is usually found in a deep location ina large muscle about the thigh, hip or retroperitoneal area. Thesetumors usually present with symptoms of pain along with a tumormass that has been present for at least 3 or 4 months, but sometimesthese lesions can be asymptomatic. The gross appearance of thetumor is a multinodular lesion that can have separate satellite lesionslocated within the same muscle belly, usually at the upper or lowerpole of the lesion. On MRI, the lesion may demonstrate centralnecrosis. The color is a dirty gray to reddish tan. Because this tumor
  111. 111. is usually high grade, it demonstrates a high index of mitotic activityand the cell types usually found are malignant fibroblasts mixedwith anaplastic pleomorphic histiocytes. This tumor has a highpotential to metastasize to the lung in about 40-45% of cases. It cango to regional lymph nodes in 10% of cases. With appropriatesurgical and adjuvant therapy, the local recurrence rate is in theneighborhood of 10-15% after a wide surgical resection. When thesetumors are located in a superficial, subcutaneous location andpresent with a size less than 5 cm, the overall prognosis is muchbetter, with only a 20% chance of metastasis to the lung. However, inthe more common, deeply located lesions that measure over 5 cm indiameter, the overall survival rate is 55%. The usual treatment for the high grade MFH is a wide surgicalresection when possible. If the tumor is too large and cannot beresected safely because of major neurovascular invasion or multiplecompartmental contamination, an aggressive high level amputation issometimes indicated. Following surgical resection, most patients
  112. 112. with the more aggressive lesions will be treated with adjuvantpostoperative radiation therapy, in the neighborhood of 6500 centigray to the tumor site, with a wider field of 5500 centigray outsidethe surgical site. At some institutions, patients will be treated withpreoperative radiation therapy, up to about 5500 centigray, withan additional 1000 centigray being delivered two weeks aftersurgery. The use of adjuvant chemotherapy for high grade soft tissuesarcomas is quite controversial because there is minimal data tosuggest that the prognosis is significantly improved with its use.Medical oncologists tend to discourage the use of this adjuvant,especially in older patients who cannot tolerate the high toxicitylevels of current protocols. The myxoid variant of the MFH is the second most commontype of MFH. Grossly it has a myxoid appearance and, because ofthis, the chance of local contamination at the margins (with localrecurrence) is much higher. However, the metastatic rate to the lungis only 25% giving the patient a better prognosis for survival.
  113. 113. The giant cell variant, occurring in large muscle groups in olderpatients, has a tendency to be a hemorrhagic tumor with a highpulmonary metastatic rate of 50%. The inflammatory MFH is alsoseen in older patients and is more common in the retroperitonealarea, with a 50% metastatic rate to the lung.
  114. 114. CLASSICCase #25860 year maleMFH adductorcompartmentCoronal T-1 MRI
  115. 115. Coronal T-2 MRI
  116. 116. Axial T-2 MRI
  117. 117. Widely resected specimen
  118. 118. Specimen cut in path lab
  119. 119. Photomic
  120. 120. Higher power showing pleomorphic cells
  121. 121. Case #258.1 MFH Cor T-1 STIR 74 year male with painful mass adductor compartment 3 mos
  122. 122. Axial T-1 T-2 Gad
  123. 123. Case #258.2 Axial MRI MFH T-1 T-2 Gad C64 year female with painfuland enlarging buttock massfor 4 months
  124. 124. Sag T-1 T-2
  125. 125. Cor T-1 PD
  126. 126. Case #258.3 MFH 55 year male with painful soft tissue mass right hip for 3 mos
  127. 127. Cor T-1 T-2 T-2
  128. 128. Sag T-2
  129. 129. Thigh axial T-2Pelvic axial T-2
  130. 130. Case #258.4 Axial T-1 T-2 Gad 65 yr old male with painful mass in buttock for 4 months
  131. 131. Cor T-1 T-2 Gad
  132. 132. Sag T-2 Gad
  133. 133. Case #259 Axial T-1 MRI 72 year male with MFH posterior compartment thigh
  134. 134. Axial T-2 MRI
  135. 135. Photomic
  136. 136. Case #259.1 MFH Thigh Axial CT scan posterior 11-08 11-0840 yr male with multiple surgeries over last 7 yrs for soft tissue MFH of posterior thigh and distal femur with this recurrence in 11-08
  137. 137. 3-2010 Cor T-1 T-2Local recurrence over 1 year post AK amp and RT
  138. 138. Axial T-1 T-2 3-10 gad
  139. 139. Anterior flap hip disarticulation
  140. 140. Case #259.1 Giant cell variant of MFH 30 year male with enlarging painful thigh mass for 6 months
  141. 141. Axial T-1 T-2 Gad
  142. 142. Cor T-1 T-2 Gad
  143. 143. Sag T-2 Gad
  144. 144. Wide resection
  145. 145. Case #259.2 MFH with skip lesions 64 year male with painful soft tissue mass in thigh for 6 mos
  146. 146. Cor STIR Ant STIR Gad
  147. 147. Axial T-2 Lower T-2Lower Gad
  148. 148. Sag Gad Gad
  149. 149. Case # 260 Axial T-1 MRI 67 year male with subcutaneous MFH thigh
  150. 150. Axial T-2 MRI
  151. 151. Sagittal T-2 MRI
  152. 152. Case #26162 year femaleMFH anterior thighAP x-ray
  153. 153. Sagittal protondensity MRI
  154. 154. Sagittal T-2 MRI
  155. 155. Axial proton density MRI
  156. 156. Axial T-2 MRI
  157. 157. Case #261.1 55 yr female with enlarging and painful popliteal mass for 5 mos
  158. 158. Sag T-1 T-2 Gad
  159. 159. Axial T-1 T-2 FS Gad
  160. 160. Cor T-1 T-2 Gad
  161. 161. Surgical resection
  162. 162. Case #262 Axial T-1 MRI 43 year female with juxta scapular myxoid MFH
  163. 163. Axial T-2 MRI
  164. 164. Another T-2 MRI
  165. 165. Case #263 Coronal proton density MRI tumor 72 year female with MFH deltoid muscle
  166. 166. tumorAnother proton density coronal cut
  167. 167. Resected specimen cut in path lab
  168. 168. Photomic
  169. 169. Case #263.1 MFH83 year male withpainful axillary mass3 months
  170. 170. CT scan
  171. 171. Cor T-1 T-2 Gad
  172. 172. Axial T-1 T-2 FS Gad
  173. 173. Case #263.2 MFH arm 66 yr female with DM and growing painful mass above elbow with slight elbow flexion contracture
  174. 174. Sag T-1 PD
  175. 175. Axial T-1 PD
  176. 176. Wide surgical resection
  177. 177. Case #264 79 year female with MFH forearm
  178. 178. Sagittal T-1 MRI
  179. 179. Axial T-1 MRI
  180. 180. Axial T-2 MRI
  181. 181. Case #264.1 78 year old female with painful mass forearm for 4 months
  182. 182. Sag T-1 T-2 Gad
  183. 183. Axial T-1 T-2 Gad
  184. 184. Case #265 Axial T-2 MRI blood 65 year old female with large hematoma in MFH thigh
  185. 185. tumorblood Axial proton density MRI
  186. 186. muscleblood Axial T-2 MRI
  187. 187. tumorCoronal T-1 MRI blood
  188. 188. Case #265.1 MFH45 year male withlarge forearm hematomaand small MFH at base bloodof hematoma MFH
  189. 189. MFHAxial T-1 MRI blood
  190. 190. Case #117478 year female withlarge hematoma inbuttock area lookinglike a hemorrhageinto an MFHT-2 MRI showingfluid-fluid level
  191. 191. Axial T-1 MRI showing fluid-fluid level
  192. 192. Case #1175 Sagittal T-2 MRI showing fluid-fluid level 37 year female with recurrent hematoma from injury 16 years ago looking like hemorrhage into an MFH
  193. 193. Axial T-1 MRI
  194. 194. Case #1175.1 Old hematoma MFH pseudotumor55 year male with non tendermass in pretibial area one year
  195. 195. Sag T-2 Gad
  196. 196. Cor PD FS Axial Gad
  197. 197. Case #1175.2 MFH pseudotumor - hematoma 81 year male with liver lymphoma and recent tender mass in posterior thigh 6 months ago without trauma
  198. 198. Axial T-1 T-2 Gad
  199. 199. Sag T-1 T-2 Gad
  200. 200. Case #1175.3 Hematoma Pseudotumor 62 yr male with soft mass anterior to patella 6 months
  201. 201. Case #1175.1 Cat scratch fever MFH pseudotumor68 year female with tender swelling inner thigh 3 months
  202. 202. Coronal STIR Sagittal T-2
  203. 203. Axial T-1Axial PD
  204. 204. Low & High Grade Fibromyxoid Sarcoma
  205. 205. Case #1178 biopsy biopsy55 year male with low grade fibromyxoid sarcoma shoulder
  206. 206. tumorCT scan
  207. 207. tumorAnother CT cut
  208. 208. tumorAxial T-1 MRI
  209. 209. tumorAxial T-2 MRI
  210. 210. Surgical specimen
  211. 211. Closer look similar to desmoid tumor
  212. 212. Photomic
  213. 213. Photomic showing myxoid area
  214. 214. CT chest shows pulmonary mets
  215. 215. Case #1178.1 Low grade fibromyxoid sarc of Foot Cor T-135 year female withtender lump on dorsumof foot 6 months Gad
  216. 216. Axial T-1 Gad
  217. 217. Case #1178.2 Low Grade Fibromyxoid Srcoma Forearm Axial T-1 T-2 FS Gad 39 year old male with slow growing tender mass in calf for 1 year
  218. 218. Sag T-1 T-2 FS Gad
  219. 219. Case #1178.3 High grade Fibromyxoid Sarcoma Cor T-1 T-2 79 yr old female with painful lump in arm for 5 months
  220. 220. Axial T-2 FS Gad
  221. 221. Surgical resection
  222. 222. Case #1178.4 Low Grade Fibromyxoid Sarcoma Axial T-1 T-2 Gad 57 yr female with tender mass over lateral thigh 1 yr
  223. 223. Cor T-1 T-2 Gad
  224. 224. Case #1178.5 Recurrent Fibromyxoid Sarcoma of Arm Axial T-2 Gad 50 yr female with history of soft tissue tumor resected from medial aspect of arm followed with RT 6500 rads 1 yr ago
  225. 225. Sag T-2 Cor T-2 Cor Gad
  226. 226. Fibrosarcoma
  227. 227. Fibrosarcoma The soft tissue fibrosarcoma is clinically very similar to the MFH,except for the absence of malignant-appearing histiocytes. Thefibrosarcoma is less common compared to the MFH and occurs in aslightly younger age group between the ages of 30 and 55 years,with equal involvement in males and females. This tumor can bevery low grade, similar to a desmoid tumor, in which case it growsslowly and is relatively painless. The high grade lesions are fastergrowing, more painful and carry a worse prognosis. These tumorstend to affect deep fascial structures, around muscles in the area ofthe knee and thigh, followed next by the forearm and leg. Grossly,the fibrosarcoma has a firm lobulated pattern with a yellowish-whiteto tan coloration. Occasionally, there will be calcific ossifyingdeposits seen on x-ray examination. Histologically, the fibrosarcomais composed of spindle cells that form collagen fiber with varyingdegrees of mitotic activity from grade I through grade III or IV,
  228. 228. but there are no malignant histiocytes seen the fibrosarcoma. The treatment and prognosis depends on the grade of the tumor,with the grade I lesions behaving much like a desmoid tumor with avery slight potential for pulmomary metastases, whereas the gradeIV have a high potential for metastasis to the lung in about 50-60%of cases. It is rare to see lymph node involvement. Treatmentconsists of wide surgical resection. With the larger deep lesions,resection is usually followed by local radiation therapy to the extentof 6500 centigray, however the use of adjuvant chemotherapy isconsidered controversial. As in the treatment of MFH, chemotherapyis not usually advocated by medical oncologists.
  229. 229. CLASSIC Case #266 Axial T-2 MRI41 year malefibrosarcomaforearm
  230. 230. Coronal T-2 MRI
  231. 231. Axial T-2 MRI
  232. 232. Wide resection specimen cut in path lab
  233. 233. Photomic
  234. 234. Higher power
  235. 235. Case #267 Coronal proton density MRI 55 year male with fibrosarcoma vastus intermedius
  236. 236. Axial T-2 MRI
  237. 237. Surgical specimen cut in path lab
  238. 238. Photomic
  239. 239. Case #117952 year male withfibrosarcoma arm tumorAxial T-1 MRI
  240. 240. tumorAxial T-2 MRI
  241. 241. Surgical specimen
  242. 242. Photomic
  243. 243. Case #1180 Axial T-2 MRI 26 year male with fibrosarcoma calf
  244. 244. Case # 1181 Sagittal T-1 MRI 51 year female with fibrosarcoma ankle
  245. 245. Axial T-1 MRI
  246. 246. Dermatofibrosarcoma Protuberans
  247. 247. Dermatofibrosarcoma Protuberans The dermatofibrosarcoma protuberans is considered a low tointermediate grade fibrohistiocytic tumor characteristic in its nodularcutaneous location and occurring far more often in males then infemales, in a young to middle-aged adult population. It is mostcommonly found in the trunk or proximal extremities and can beassociated with antecedent trauma in about 15% of cases. It usuallycomes on gradually as a subcutaneous nodule that is relativelypainless and therefore patients may not present to a physician fortreatment for many years. Histologically, the tumor consists of lowgrade spindle cells without evidence of mitotic activity and lowgrade histiocytes. The spindle cell pattern is typically a storiformone, similar to the fibrosarcoma and MFH. The tumor tends to invadeinto the adjacent subcutaneous fat and skin and requires a very widesurgical resection to avoid a high local recurrence rate. The chanceof pulmonary metastasis, however, is very low (1%). With a success-ful wide resection there is no need for adjuvant therapies.
  248. 248. CLASSIC Case #268 30 year male with dermatofibrosarcoma protuberans on the bottom of the heel
  249. 249. Macro section of resection specimen
  250. 250. Photomic
  251. 251. Higher power
  252. 252. Case #269 Dermatofibrosarcoma protuberans resection specimen
  253. 253. Specimen cut in path lab
  254. 254. Macro section
  255. 255. Photomic
  256. 256. Leiomyosarcoma
  257. 257. Case #1182 Axial PD MRI 47 year female with leiomyosarcoma inguinal area
  258. 258. Axial T-1 MRI
  259. 259. Coronal PD MRI showing tumor arising from femoral vein
  260. 260. Photomic
  261. 261. Case #1182.1 Metastatic leiomyosarcoma from uterus to hip Axial T-2 57 yr female with hip pain 3 months Cor PD
  262. 262. CT scans pelvis PET scan
  263. 263. CT scan chest PET scan