Soft tissue tumours 2019
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Soft tissue tumours, classification, imaging features, adipocytic, fibrocytic, histiocytic, vascular, pericytic, myocytic, neurogenic, undifferentiated etc
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Soft tissue tumours 2019
- 1. + SOFT TISSUE TUMOURS DR ANUSHUYA JUNIOR RESIDENT 30/10/19 Anu@StanleyRadiologyDept
- 2. + WHO CLASSIFICATION 30/10/19Anu@StanleyRadiologyDept 2 ADIPOCYTIC FIBROBLASTIC/MYOFIBROBLASTIC SO CALLED FIBROHISTIOCYTIC SMOOTH MUSCLE SKELETAL MUSCLE PERICYTIC or PERIVASCULAR VASCULAR CHONDROOSSEOUS TUMORS OF UNCERTAIN DIFFERENTIATION
- 16. + MACRODYSTROPHIA LIPOMATOSA WITH LIPOMATOSIS OF THE MEDIAN NERVE 30/10/19Anu@StanleyRadiologyDept 16
- 17. + LIPOMATOSIS OF LUMBAR PLEXUS 30/10/19Anu@StanleyRadiologyDept 17
- 32. + ATYPICAL LIPOMATOUS TUMOUR 30/10/19Anu@StanleyRadiologyDept 32
- 40. + NORA’s lesion or BPOP -Benign parosteal osteochondromatous proliferation 30/10/19Anu@StanleyRadiologyDept 40
- 43. + FIBROUS HAMARTOMA OF INFANCY 30/10/19Anu@StanleyRadiologyDept 43
- 48. + JUVENILE HYALINE FIBROMATOSIS PURETIC SYNDROME 30/10/19Anu@StanleyRadiologyDept 48
- 49. + JUVENILE HYALINE FIBROMATOSIS PURETIC SYNDROME 30/10/19Anu@StanleyRadiologyDept 49
- 51. + FIBROMA OF TENDON SHEATH 30/10/19Anu@StanleyRadiologyDept 51
- 54. + CALCIFYING (or) JUVENILE APONEUROTIC FIBROMA 30/10/19Anu@StanleyRadiologyDept 54
- 56. + BENIGN FIBROUS TUMOURS 30/10/19Anu@StanleyRadiologyDept 56 Nodular and Proliferative Fasciitis Bizarre Parosteal Osteochondromatous Proliferation Elastofibroma Fibrous Hamartoma of Infancy Myofibroma/Myofibromatosis Fibromatosis Colli Juvenile Hyaline Fibromatosis Fibroma of Tendon Sheath Desmoplastic Fibroblastoma Calcifying Aponeurotic Fibroma
- 57. + FIBROBLASTIC TUMOURS 30/10/19Anu@StanleyRadiologyDept 57 BENIGN INTERMEDIATE FIBROUS TUMOURS Superficial fibromatosis Desmoid type fibromatosis INTERMEDIATE FIBROHISTICYTIC TUMOURS SFT IMT Infantile fibrosarcoma MALIGNANT Fibrosarcoma Myxoid fibrosarcoma LG fibromyxoid sarcoma Sclerosing epitheloid fibrosarcoma
- 58. + SUPERFICIAL FIBROMATOSES LEDDERHOSE DISEASE 30/10/19Anu@StanleyRadiologyDept 58
- 59. + SUPERFICIAL FIBROMATOSES LEDDERHOSE DISEASE 30/10/19Anu@StanleyRadiologyDept 59
- 60. + SUPERFICIAL FIBROMATOSES DUPUYTREN’S CONTRACTURE 30/10/19Anu@StanleyRadiologyDept 60
- 61. + DESMOID TYPE FIBROMATOSIS EXTRA ABDOMINAL 30/10/19Anu@StanleyRadiologyDept 61
- 62. + DESMOID TYPE FIBROMATOSIS INTRA ABDOMINAL 30/10/19Anu@StanleyRadiologyDept 62
- 63. + DESMOID TYPE FIBROMATOSIS ABDOMINAL WALL 30/10/19Anu@StanleyRadiologyDept 63
- 65. + SOLITARY FIBROUS TUMOUR (or) HEMANGIOPERICYTOMA 30/10/19Anu@StanleyRadiologyDept 65
- 76. + FIBROBLASTIC TUMOURS 30/10/19Anu@StanleyRadiologyDept 76 BENIGN INTERMEDIATE FIBROUS TUMOURS Superficial fibromatosis Desmoid type fibromatosis INTERMEDIATE FIBROHISTICYTIC TUMOURS SFT IMT Infantile fibrosarcoma MALIGNANT Fibrosarcoma Myxoid fibrosarcoma LG fibromyxoid sarcoma Sclerosing epitheloid fibrosarcoma
- 78. + TENDON SHEATH GCT 30/10/19Anu@StanleyRadiologyDept 78
- 82. + DIFFUSE TYPE GCT (Extra articular PVNS) 30/10/19Anu@StanleyRadiologyDept 82
- 83. + DEEP BENIGN FIBROUS HISTIOCYTOMA 30/10/19Anu@StanleyRadiologyDept 83
- 85. + So called fibrohistiocytic tumours 30/10/19Anu@StanleyRadiologyDept 85 BENIGN GCT – tendon sheath GCT – diffuse type Deep BFH MALIGANT Undifferentiated pleomorphic sarcoma UPS with inflammation Dermatofibrosarcoma protuberans
- 88. + UPS WITH PROMINENT INFLAMMATION 30/10/19Anu@StanleyRadiologyDept 88
- 90. + SMOOTH MUSCLE & SKELETAL MUSCLE TUMOURS 30/10/19 Anu@StanleyRadiologyDept 90
- 100. + PERIVASCULAR AND VASCULAR TUMOURS 30/10/19 Anu@StanleyRadiologyDept 100
- 105. + KLIPPEL TRENAUNAY WEBER SYNDROME 30/10/19Anu@StanleyRadiologyDept 105
- 116. + ES MESENCHYMAL CHONDROSARCOMA 30/10/19Anu@StanleyRadiologyDept 116
- 118. + TUMOURS OF UNCERTAIN DIFFERENTIATION 30/10/19 Anu@StanleyRadiologyDept 118
- 120. + OSSIFYING FIBROMYXOID TUMOUR 30/10/19Anu@StanleyRadiologyDept 120
- 123. + SYNOVIAL SARCOMA TRIPLE SIGN 30/10/19Anu@StanleyRadiologyDept 123
- 124. + SYNOVIAL SARCOMA bunch of grapes sign 30/10/19Anu@StanleyRadiologyDept 124
- 127. + PNET/ ES EWING’S SARCOMA 30/10/19Anu@StanleyRadiologyDept 127 ASKIN S TUMOUR
- 128. + PERIPHERAL NERVE SHEATH TUMOURS 30/10/19 Anu@StanleyRadiologyDept 128
- 131. + NEUROFIBROMA & SCHWANNOMA 30/10/19Anu@StanleyRadiologyDept 131 TARGET SIGN FASCICULAR SIGN
- 132. + PLEXIFORM NEUROFIBROMA “Bag of worm” appearance 30/10/19Anu@StanleyRadiologyDept 132
- 133. 30/10/19Anu@StanleyRadiologyDept 133 Differentiated from MPNST cut off SUV < 6.1 Cannot be differentiated Nuclear medicine FDG PET
- 134. + MALIGNANT PNST Large size > 5 cms Peripheral enhancement pattern Perilesional edema zone Presence of intratumoral cystic lesion 30/10/19Anu@StanleyRadiologyDept 134
- 135. + SKIN AND SUBCUTANEOUS LESIONS 30/10/19 Anu@StanleyRadiologyDept 135
- 140. + INFECTION/ INFLAMMATION 30/10/19Anu@StanleyRadiologyDept COMPARTMENT SYNDROME FOREIGN BODY GRANULOMA
- 141. + INFECTION AND INFLAMMATION 30/10/19Anu@StanleyRadiologyDept 141 SOFT TISSUE ABCESS BURSITIS SYNOVITIS ARTHROPLASTY COMPONENT WEAR/PARTICLE DISEASE FOREIGN BODY GRANULOMA MYOSITIS CAT SCRATCH DISEASE DENERVATION HYPERTROPHY
- 142. + VASCULAR MIMICS 30/10/19Anu@StanleyRadiologyDept 142 POPLITEAL ARTERY PSEUDOANEURYSM DIABETIC MYONECROSIS
- 143. + VASCULAR MIMICS 30/10/19Anu@StanleyRadiologyDept 143 HAEMATOMA ANEURYSM PSEUDOANEURYSM CYSTIC ADVENTITIAL DISEASE AV FISTULA DIABETIC MYONECROSIS CALCIFIC MYONECROSIS MOREL LAVALLEE LESION
- 144. + CRYSTAL DISEASE 30/10/19Anu@StanleyRadiologyDept 144 CPPD CALCINOSIS CIRCUMSCRIPTA
- 145. + CRYSTAL DISEASE 30/10/19Anu@StanleyRadiologyDept 145 GOUT CPPD HAD TUMORAL CALCINOSIS CALCINOSIS OF RENAL FAILURE CALCINOSIS UNIVERSALIS CALCINOSIS CIRCUMSCRIPTA
- 147. + OTHER MIMICS 30/10/19Anu@StanleyRadiologyDept 147 MYOSITIS OSSIFICANS GANGLION /SYNOVIAL CYST FAT NECROSIS AMYLOID DEPOSITION POSTINJECTION FIBROSIS HEMOPHILIA HOFFA DISEASE GRANULOMA ANNULARE FASCIAL HERNIA
- 148. + 30/10/19 Anu@StanleyRadiologyDept 148 DIFFERENTIAL DIAGNOSIS THANK YOU
Editor's Notes
- Classifies neurogenic and skin tumors as a separate entity
- Mucinous material inversely related to differentiation
- 50% of soft tissue masses, ct – 65 to – 120 HU, septa <2 mm diameter, no capsule. MRI – T1 hyper comparable to sc fat, T2 hyper, completely fat suppressible. Doppler- no pae, no flow Suspect malignancy – thick septa, nodules, retroperitoneal location, mineralisation. T1/T2FS
- T1/PDFS Fatty mass in the deltoid with entrapped muscle fibres
- T1/T2FS Diffuse overgrowth or regional deposition of mature adipose tissue, clinical – depending on the location. Adiposis dolorosa or dercum disease /madelung disease– multiple sc painful lipomas. Affects post menopausal women , psychiatric symptoms.
- Cxr – med widening / double contour effect – shadows of fat with normal med structures Clinical- associated with steroid excess, cough, decreased IVC return,
- IVP – medial deviation of ureters, pear shaped bladder, elevated bladder base. Ct – perirectal and perivesical fat infiltration, straightened or narrow recto-sigmoid colon.
- Chronic inflammation causing atrophy of renal tissue / worsened by steroids. IVU – effacement and stretcing of PCS CT & MR – fat proliferation in parapelvic region with renal parenchymal atrophy
- Axial ct/ sag T1 Low density mass in midline posterior fossa, with smaller masses in bl CP angles. Sag shows extending into upper cervical canal and another lipoma in cp angle cistern.
- 2 yrs later - Axial pd / t1sag- increase in size of the lesion, extending to middle cranial fossa. Chemical shift artifact on the anterior margins of the lesion. Fishman syndrome or haberland syndrome
- Overgrowth of normal epidural fat Can cause radicular pain and spinal cord compression
- Overgrowth of thumb and index finger, bony overgrowth +, from birth women, Usg – of median nerve - Coaxial cable appearance in cross section
- Lipomatosis of median nerve Median >digital br of median n >ulnar >radial
- Axial and coronal T1 Fat containing mass in the right psoas muscle with central nodlarity Coronal depicts branching of lumbar plexus
- Coonal T1/ T2FS Papillary masses in the knee jt. It could be synovial proliferation but it has fat signal intensity. Large joint effusion –chronic inflammation.
- Axial gradient echo mage – the fat had similar intensity to sc fat in other sequences/but to marrow fat in gradient sequence.
- Infiltration of fat tissue in the synovium and subsynovial tissue forming frond like masses Kneejt mc. Unilateral in 94%.
- Lateral radiograph demonstrates a moderately large lucency ſt within the mid calf. No periosteal reaction or soft tissue calcification is present. Immature growth plates in a child.
- Axial T1T2FS. Young age should suggest Benign paediatric tumour –lipoblastoma. Present within 3 yrs of age. Circumscribed and diffuse forms. Resembles fetal adipose tissue. Myxoid+. Critical structures.
- Axial T1 / axial STIR Mass st in the posterior compartment of the upper arm. Intensity higher than muscle but not as high as sc fat. predominantly complex appearance containing septa and enlarged vessels. Stir -hyper
- T1/T2FS Intensity/ septa/blood vessels
- T1/t2fs/t1fs+c/cect Large vessels seen along periphery and within the mass. Similar vascularity in liposarcoma.
- Angio in a similar presacral lesion –vascular blush. Avid tracer uptake on PET m. c location –thigh, >sholuder back neck chest arm. middle aged, 4 variants –typical, myxoid, lipoma like, spindle cell
- AP radiograph of thigh – bizarre periosteal reaction perpendicular to the shaft. There is both cortical thickening and scalloping.
- Axial T1/T1FS C/cor t1 Density same as sc fat/ osseous excresence or a perosteal new bone
- Ct – fat density lesion abutting the shaft with osseous excresence. Femur mc. No therapeutic implications – unless nerve compression
- Axialt1/t1fsc -Large fatty lesion significanty displacing pc musculature. Key -Numerous septa.
- Nodular enhancement on t1c
- Well differentiated liposarcoma. Locally aggressive tumour which can dedifferentiate into liposarcoma – sclerosing variant mc. Deep extremities, thigh mc. Retroperitoneal 80% mortality.
- T1/pdfs Myxoid content, <25 % fat. Fat tail +, Dd – intramuscular myxoma
- Axial t1/ t2fs –myxoid bright /t1fsc –hypoenhancement-necrosis/haemorrhage Iv contrast must.
- T1/t2fs Lack of fat and presence of myxoid bright tail. But Contrast – moderate enhancement.
- Ct – large heterogenous enhancing lesion. T2fs – heterogenous signal intensity. Little fat. Pleomorphic – pleomorphic lipoblasts, mean diameter >10 cms. Aggressive clinical course with worse outcome.
- T1/t2fs Bimorphic appearance – differing deep & superficial. Wdl – ddl. Takes 7-8 yrs. Retroperitoneum > extremities.
- T1 / t2fs/ t1 c – well defined mass in the upper arm, hyper on t2, flame shaped high signal on either side. Dd – pnst,myxoma. But location at the intersection of muscle and fascia – nodular fasciitis. Tender, surgical excision. Upper extremity mc
- Mineralized mass on bone surface. Dd – periosteal chondroma, osteochondroma. Cleavage plane bw mass and bony cortex. Discontinuous Medullary canal. Bpop – disorganised mass of fibrous tissue with bone and cartilage. Mildly painful, excision.
- Crescentic or lenticular fbrous mass entrapped between fat . Location – between scapula nd chest wall. Deep to lattismus and rhomboid major. Reactve lesion due to friction between scapula and chest wall. No malignant transformation. Excised if symptomatic.
- Rapidly growing sc mass in infants, mc males, location – axilla, upper arm and shoulder. Mr – soft tissue mass isointense to muscle + fat –hyperechoic on usg. Simulate malignancy – but benign. No maligant potential.
- Radiograph showing Lobulated lucent lesion in the metaphysis with sparing of region adjacent to physis, eccentric location. Faint central calcification may be present – myofibroma. Mc fibrous tumour of infancy. It can involve bone, muscle or viscera. Half –solitary, c or sc, head and neck.
- Less than 2 yrs, male predominance, no malignant potential, may regress spont, sx.
- Usg – distal neck shows fusiform thickening of distal sternocleidomastoid muscle, Pseudotumour or sternomastoid tumour. Presentation – torticollis. Spontaneous regression – 70 %.
- T1c – diffuse enhancement of scm, Fibrous proliferation in scm muscle
- AR disease, Skin and sc Nodules, multiple discrete lytic bone lesions, gingival hyperplasia. Mr – non specific.
- Enlarged deformed great toe, lobulated soft tissue mass + erosion of adjacent bones. Similar lesions in parents – help in diagnosis
- Soft tissue mass with no adjacent bone erosion
- Slowly growing benign soft tissue nodule adjacent to tendon sheath. Upper extremity mc, Painless, sx. T1 –hypo, t2 –central hyper – cystic degeneration.
- T1/t2fs - Hypo in both / Rich vascularity in doppler. Collagenous fibroma. Sx. Extremities mc, sc location.
- Axial and cor t1fs c –persistently low signal intensity.
- T1 /t2fs / t1fs c Growth plates /speckled foci of low signal-stippled calcifications / intense enhancement. Erosion + Small slowly growing mass in child –palms soles wrist and ankles. Recurrence -50 %
- Calcifying/juvenile aponeurotic fibroma x ray
- Locally infiltrative aggressive, fibroblastic lesions involving plantar fascia. T1/t2fs Non weight bearing sole / plantar fascia / X ray – flexion deformity / plantar 2-3 cms, medial location
- Cor t1/ t1fs c
- Palmar - <1 cm, 50 % bilateral, volar 4532 peyronie
- T1 /STIR – homogenous persistently low signal
- Gardner syndrome/ small bowel mesentery/ likely to recur/ short gut syndrome
- Rectus abdominis and internal oblique muscles 3-7 cms, painless mass during or after pregnancy, least likely to recur Commonly in females 20-30 years old
- Intensely enhancing cect – hypervascular in angio, Paraspinal hemangiopericytoma. Thin walled branching Staghorn configuration of vessels
- T1/stir/pdfs – large feeding vessels-intense enhancement Paraneoplastic syndrome – IGF – Hypoglycemia. 10-15 % recur mets/ aggressive – mediastinal rp location/ Overall prog good
- Axial ct/stir/ t1c – mass involving ant tendinous insertion of lateral rectus muscle. INFLAMMATORY PSEUDOTUMOUR. Mc lung and orbit. Children & young adults.
- Found throughout the body. Fever, night sweats, wt loss, Sx, nsaids, steroids.
- Rare, malignant neoplasm of infancy. Pain less rapidly enlarging mass in extremity, amputation. Less aggressive than adult fs
- T1/t2 forearm
- Ct/ t1c –large necrotic areas.
- Lower leg –t2/t1c All muscles of ant compartment, mets – lung and axial skeleton Central non enh necrosis
- Ct t1 t2fs tt1c
- homogenous
- Heterogenous Thigh mc location
- Central geographic areas of non enhancement is typical Poorly differentiated – painful 33 %, mets 43%, recur 50%, mortality 50%
- Benign synovial proliferation in tendon sheath Erosions Lobulated, intermediated in t1 t2, intense enhancement.
- T1 t2 t1c
- Lobulated mass in the peri-articular tissues, lacks villi, knee,thigh, more aggressive needs wide sx
- Median size – 3 cms, low on t1 and t2,
- Ext>head and neck
- Fluctuant, extensively haemorrhagic lesion-mimicking haematoma or abcess
- T1 t2 t1c Low grade sarcoma of dermis and cutis, transform+, mets +, young middle aged males
- Benign painful neoplasm knee thigh females
- Straight linear vessels with convergence to one point
- Cor fs t2
- Bulbous end Spindle irritation rt tibial nerve