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Lawson B, Rajendran I, Smith J, Shakur A, Sadler V, Sadler TJ, Addley HC, Freeman S. Mimics of primary ovarian cancer and primary peritoneal carcinomatosis - A pictorial review. Clin Radiol 2024; 79:736-748. [PMID: 39068115 DOI: 10.1016/j.crad.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
Numerous conditions can mimic ovarian malignancy. Identifying the origin of a pelvic mass or disseminated peritoneal abnormality on imaging is important to ensure that the patient receives optimal management by the appropriate clinical team. Ovarian cancer mimics include infections and other neoplastic processes, for example, actinomycosis, lymphoma, and sarcoma. We will illustrate intraperitoneal and extraperitoneal ovarian and non-ovarian mimics. Primary peritoneal carcinomatosis mimics include processes such as deep infiltrating endometriosis and rare causes such as gliomatosis peritonei and diffuse peritoneal leiomyomatosis. We aim to illustrate the multimodality key imaging appearances of common and rarer types of mimics.
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Affiliation(s)
- B Lawson
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - I Rajendran
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - J Smith
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - A Shakur
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - V Sadler
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - T J Sadler
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - H C Addley
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - S Freeman
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Vulasala SS, Virarkar M, Karbasian N, Calimano-Ramirez LF, Daoud T, Amini B, Bhosale P, Javadi S. Whole-body MRI in oncology: A comprehensive review. Clin Imaging 2024; 108:110099. [PMID: 38401295 DOI: 10.1016/j.clinimag.2024.110099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
Whole-Body Magnetic Resonance Imaging (WB-MRI) has cemented its position as a pivotal tool in oncological diagnostics. It offers unparalleled soft tissue contrast resolution and the advantage of sidestepping ionizing radiation. This review explores the diverse applications of WB-MRI in oncology. We discuss its transformative role in detecting and diagnosing a spectrum of cancers, emphasizing conditions like multiple myeloma and cancers with a proclivity for bone metastases. WB-MRI's capability to encompass the entire body in a singular scan has ushered in novel paradigms in cancer screening, especially for individuals harboring hereditary cancer syndromes or at heightened risk for metastatic disease. Additionally, its contribution to the clinical landscape, aiding in the holistic management of multifocal and systemic malignancies, is explored. The article accentuates the technical strides achieved in WB-MRI, its myriad clinical utilities, and the challenges in integration into standard oncological care. In essence, this review underscores the transformative potential of WB-MRI, emphasizing its promise as a cornerstone modality in shaping the future trajectory of cancer diagnostics and treatment.
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Affiliation(s)
- Sai Swarupa Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States.
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Niloofar Karbasian
- Department of Radiology, McGovern Medical School at University of Texas Health Houston, Houston, TX, United States
| | - Luis F Calimano-Ramirez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Taher Daoud
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Priya Bhosale
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanaz Javadi
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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3
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Lucero KAJ, Woo KI. Orbital Liposarcoma Progression From a Well-Differentiated to a Dedifferentiated Type in a Young Patient. Ophthalmic Plast Reconstr Surg 2024; 40:e16-e19. [PMID: 37721315 DOI: 10.1097/iop.0000000000002522] [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: 09/19/2023]
Abstract
A young male patient presented with unilateral proptosis of the left eye. Laboratory tests and an initial computed tomography scan of the orbit were compatible with euthyroid orbitopathy. He subsequently underwent decompression surgery for unfavorable cosmesis and corneal exposure symptoms with good results, but returned 1 year later for recurrence of proptosis. There was a superomedial fatty density extraconal mass on computed tomography scan. A biopsy done a year later confirmed the diagnosis of well-differentiated liposarcoma from the previously noted mass and a dedifferentiated component in the newly appeared mass in the intraconal space. Orbital exenteration with radial forearm free flap was performed followed by orbital radiotherapy. No disease recurrence or metastasis was seen on follow-ups for 7 years since undergoing treatment.
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Affiliation(s)
- Kate Angelli J Lucero
- Department of Ophthalmology, Vicente Sotto Memorial Medical Center, Cebu, Philippines
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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4
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Pathak P, Wondimu B, Jalilianhasanpour R, Pooyan A, Matesan MC, Mansoori B. Skin Malignancies: Imaging Review with Radiologic-Histopathologic Correlation. Radiographics 2023; 43:e230093. [PMID: 38032822 DOI: 10.1148/rg.230093] [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: 12/02/2023]
Abstract
Skin malignancies are commonly encountered as primary or incidental findings. Neoplasms that affect the skin include primary (basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma) and secondary (mesenchymal neoplasms, lymphoma, and metastases) tumors. Imaging provides valuable anatomic information (tumor size, depth of involvement, presence of distant metastasis, and data for guiding biopsy) and functional information (metabolic activity and sentinel node mapping data). This information, in addition to biopsy results, improves the histopathologic characterization of tumors and treatment planning. Various histopathologic types of the same entity exhibit different biologic behavior and have different imaging features. Familiarity with the multimodality imaging features, histopathologic characteristics, and various modes of dissemination (direct invasion; perineural, lymphatic, and hematogenous spread) of the most common skin malignancies helps radiologists narrow the differential diagnosis in clinical practice. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Priya Pathak
- From the Department of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, University of Minnesota (M-Health), 420 Delaware St SE, Minneapolis, MN 55455 (P.P.); and the Department of Pathology (B.W.); Department of Radiology (R.J., A.P.), Divisions of Nuclear Medicine (M.C.M.) and Abdominal Imaging (B.M.), University of Washington, Seattle, WA
| | - Bitania Wondimu
- From the Department of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, University of Minnesota (M-Health), 420 Delaware St SE, Minneapolis, MN 55455 (P.P.); and the Department of Pathology (B.W.); Department of Radiology (R.J., A.P.), Divisions of Nuclear Medicine (M.C.M.) and Abdominal Imaging (B.M.), University of Washington, Seattle, WA
| | - Rozita Jalilianhasanpour
- From the Department of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, University of Minnesota (M-Health), 420 Delaware St SE, Minneapolis, MN 55455 (P.P.); and the Department of Pathology (B.W.); Department of Radiology (R.J., A.P.), Divisions of Nuclear Medicine (M.C.M.) and Abdominal Imaging (B.M.), University of Washington, Seattle, WA
| | - Atefe Pooyan
- From the Department of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, University of Minnesota (M-Health), 420 Delaware St SE, Minneapolis, MN 55455 (P.P.); and the Department of Pathology (B.W.); Department of Radiology (R.J., A.P.), Divisions of Nuclear Medicine (M.C.M.) and Abdominal Imaging (B.M.), University of Washington, Seattle, WA
| | - Manuela C Matesan
- From the Department of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, University of Minnesota (M-Health), 420 Delaware St SE, Minneapolis, MN 55455 (P.P.); and the Department of Pathology (B.W.); Department of Radiology (R.J., A.P.), Divisions of Nuclear Medicine (M.C.M.) and Abdominal Imaging (B.M.), University of Washington, Seattle, WA
| | - Bahar Mansoori
- From the Department of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, University of Minnesota (M-Health), 420 Delaware St SE, Minneapolis, MN 55455 (P.P.); and the Department of Pathology (B.W.); Department of Radiology (R.J., A.P.), Divisions of Nuclear Medicine (M.C.M.) and Abdominal Imaging (B.M.), University of Washington, Seattle, WA
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Yang JL, Jin YL, Sun YS. Primary dedifferentiated liposarcoma of the pancreas: A case report and literature review. Shijie Huaren Xiaohua Zazhi 2023; 31:791-796. [DOI: 10.11569/wcjd.v31.i18.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Dedifferentiated liposarcoma (DDLPS) is a high-grade invasive tumor that more commonly occurs in the retroperitoneum, followed by the thighs and groin. DDLPS in the pancreas is very rare.
CASE SUMMARY A patient underwent CT examination due to hidden pain in the upper abdomen, which revealed a pancreatic space occupying lesion of unknown nature. Based on the patient's preoperative medical history, physical examination, and auxiliary examination, it was considered that there was a huge space occupying lesion in the head and neck of the pancreas, with clear boundaries and surgical indications. The patient underwent pancreaticoduodenectomy at our hospital, and the postoperative pathology revealed a DDLPS of the pancreas. Three months after the surgery, tumor recurrence occurred. Dacarbazine combined with epirubicin chemotherapy had a poor effect, and the patient passed away 18 mo later.
CONCLUSION Due to the fact that DDLPS of the pancreas is usually not significantly responsive to radiotherapy and chemotherapy, the currently most effective treatment method for DDLPS of the pancreas is resection with negative margin under a microscope. However, due to the deep location of liposarcoma in the pancreas and its proximity to many surrounding organs, it is difficult to completely remove the tumor, and many patients may develop regional recurrence.
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Affiliation(s)
- Jia-Li Yang
- The Second School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Yan-Ling Jin
- Cancer Center, Department of Pathology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yuan-Shui Sun
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
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Miguez González J, Calaf Forn F, Pelegrí Martínez L, Lozano Arranz P, Oliveira Caiafa R, Català Forteza J, Palacio Arteaga LM, Losa Gaspà F, Ramos Bernadó I, Barrios Sánchez P, Ayuso Colella JR. Primary and secondary tumors of the peritoneum: key imaging features and differential diagnosis with surgical and pathological correlation. Insights Imaging 2023; 14:115. [PMID: 37395913 DOI: 10.1186/s13244-023-01417-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/30/2023] [Indexed: 07/04/2023] Open
Abstract
Peritoneal malignancies represent a diagnostic challenge for abdominal radiologists, oncologists, surgeons and pathologists in multidisciplinary teams, who must address their differential diagnosis, staging and treatment. In this article, we explain the pathophysiology of these processes and lay out the role of different imaging techniques in their evaluation. Then, we review the clinical and epidemiological aspects, the main radiological features and the therapeutic approaches for each primary and secondary peritoneal neoplasm, with surgical and pathological correlation. We further describe other rare peritoneal tumors of uncertain origin and a variety of entities that may mimic peritoneal malignancy. Finally, we summarize the key imaging findings of each peritoneal neoplasm to facilitate an accurate differential diagnosis that may impact patient management.Clinical relevance statementImaging plays an essential role in the evaluation of peritoneal malignancies, assessing their extension, detecting unfavorable sites of involvement and facilitating an accurate differential diagnosis, helping to choose the best therapeutic approach.
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Affiliation(s)
- Javier Miguez González
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Francesc Calaf Forn
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Laura Pelegrí Martínez
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Pilar Lozano Arranz
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Rafael Oliveira Caiafa
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Jordi Català Forteza
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Lina Maria Palacio Arteaga
- Department of Pathology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Ferrán Losa Gaspà
- Department of Medical Oncology, Institut Català d'Oncologia Hospitalet, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Isabel Ramos Bernadó
- Peritoneal Surface Malignancies Unit, Department of Surgery, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Pedro Barrios Sánchez
- Former Director of the Peritoneal Carcinomatosis Program of Catalonia, Former Head of the Peritoneal Surface Malignancies Unit, Department of Surgery, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
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7
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Apte SS, Mor E, Mitchell C, Gyorki DE. Practical Management of Adult Ultra-Rare Primary Retroperitoneal Soft Tissue Sarcoma: A Focus on Perivascular Epithelioid Tumours and Extraosseous Ewing Sarcoma. Curr Oncol 2023; 30:5953-5972. [PMID: 37504306 PMCID: PMC10377910 DOI: 10.3390/curroncol30070445] [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: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as 'ultra-rare' sarcomas, with an incidence of ≤1-5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing's sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes.
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Affiliation(s)
- Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Catherine Mitchell
- Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Tang Y, Cui J, Zhu J, Fan G. Differentiation Between Lipomas and Atypical Lipomatous Tumors of the Extremities Using Radiomics. J Magn Reson Imaging 2022; 56:1746-1754. [PMID: 35348280 DOI: 10.1002/jmri.28167] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The differentiation of soft tissue lipomas from atypical lipoma tumors (ALTs) of the extremities is important because of the distinction of the cytogenetic profiles and the treatment decisions. PURPOSE To investigate a radiomics method to differentiate between lipomas and ALTs of the extremities. STUDY TYPE Retrospective. POPULATION Imaging data of 122 patients including 90 cases of lipomas and 32 cases of ALTs. FIELD STRENGTH/SEQUENCE Axial T1-weighted imaging and fat suppressed T2-weighted imaging at 3.0T MRI. ASSESSMENT Analysis of variance and the least absolute shrinkage and selection operator methods were used for feature selection and the random forest method was used to build three radiomics models based on T1WI, FS T2WI, and their combination (T1&T2WI). Three independent radiologists classified the tumors based on the subjective assessments. STATISTICAL TESTS The area under the curve (AUC) of the receiver operating characteristic curve, accuracy, F1-score, specificity, and sensitivity were employed. The differences of the classifiers and discriminating ability of the radiologists and the radiomics model were compared by Delong test. A P value <0.05 was considered significant. Kappa test was used to determine the inter-reader agreements between the radiologists. RESULT The AUCs were 0.952 (95% confidence interval [CI]: 0.785-0.998), 0.944 (95% CI: 0.774-0.997), and 0.968 (95% CI: 0.809-1) for T1WI, FS T2WI, and T1&T2WI models in testing sets respectively. Delong test showed there were no significant difference between the different radiomics models (P > 0.05). The AUCs of the radiologists were 0.893 (95% CI: 0.824-0.942), 0.831 (95% CI: 0.752-0.893), and 0.893 (95% CI: 0.824-0.94), respectively. There were significant difference between radiomics model and radiologists' model in the training and entire cohorts (P < 0.05) while there were no significant difference in the testing sets (P > 0.05). DATA CONCLUSION Radiomics has the potential to distinguish between lipomas and ALTs of the extremities and their discrimination ability is no weaker than the senor radiologists. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yaozhou Tang
- Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Jingjing Cui
- Department of Research and Development, Shanghai United Imaging Intelligence, Shanghai, China
| | - Jingyi Zhu
- Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Guoguang Fan
- Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
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Hochhegger B, Zanon M, Patel PP, Verma N, Eifer DA, Torres PPTES, Souza AS, Souza LVS, Mohammed TL, Marchiori E, Ackman JB. The diagnostic value of magnetic resonance imaging compared to computed tomography in the evaluation of fat-containing thoracic lesions. Br J Radiol 2022; 95:20220235. [PMID: 36125174 PMCID: PMC9733611 DOI: 10.1259/bjr.20220235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022] Open
Abstract
Intrathoracic fat-containing lesions may arise in the mediastinum, lungs, pleura, or chest wall. While CT can be helpful in the detection and diagnosis of these lesions, it can only do so if the lesions contain macroscopic fat. Furthermore, because CT cannot demonstrate microscopic or intravoxel fat, it can fail to identify and diagnose microscopic fat-containing lesions. MRI, employing spectral and chemical shift fat suppression techniques, can identify both macroscopic and microscopic fat, with resultant enhanced capability to diagnose these intrathoracic lesions non-invasively and without ionizing radiation. This paper aims to review the CT and MRI findings of fat-containing lesions of the chest and describes the fat-suppression techniques utilized in their assessment.
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Affiliation(s)
| | - Matheus Zanon
- Department of Radiology, Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul - Av. Ipiranga, Porto Alegre, Brazil
| | - Pratik P Patel
- Department of Radiology, College of Medicine, University of Florida, Gainesville, United States
| | - Nupur Verma
- Department of Radiology, College of Medicine, University of Florida, Gainesville, United States
| | - Diego André Eifer
- Department of Radiology, Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul - Av. Ipiranga, Porto Alegre, Brazil
| | | | - Arthur S Souza
- Department of Radiology, Rio Preto Radiodiagnostic Intitute – R. Cila, São José do Rio Preto, Brazil
| | | | - Tan-Lucien Mohammed
- Department of Radiology, College of Medicine, University of Florida, Gainesville, United States
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro - Av. Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Jeanne B Ackman
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School - Founders House, Boston, United States
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Gulati V, Swarup MS, Kumar J. Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach. Indian J Radiol Imaging 2022; 32:235-252. [PMID: 35924125 PMCID: PMC9340194 DOI: 10.1055/s-0042-1744142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mass lesions in the retroperitoneal space may be primary or secondary. Primary retroperitoneal mass lesions are relatively uncommon as compared to pathology that arises secondarily from retroperitoneal organs. These may be solid or cystic lesions. The overlapping imaging features of various solid primary retroperitoneal tumors make the diagnosis difficult, and hence, histopathology remains the mainstay of diagnosis. This paper provides a brief review of the anatomy of the retroperitoneal space and provides an algorithmic approach based on cross-sectional imaging techniques to narrow down the differential diagnosis of solid primary retroperitoneal masses encountered in the adult population.
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Affiliation(s)
- Vaibhav Gulati
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - M. Sarthak Swarup
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Jyoti Kumar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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11
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Evola G, Schillaci R, Reina M, Caruso G, D'Angelo M, Reina GA. Giant retroperitoneal well-differentiated liposarcoma presenting in emergency with intestinal occlusion: Case report and review of the literature. Int J Surg Case Rep 2022; 95:107152. [PMID: 35580411 PMCID: PMC9117537 DOI: 10.1016/j.ijscr.2022.107152] [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: 02/23/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Liposarcoma (LPS) represents the most common type of retroperitoneal sarcoma (RPS) and can be classified into four subtypes. Preoperative diagnosis of retroperitoneal liposarcoma (RLPS) is a challenge because of its late and nonspecific clinical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents a potentially curative treatment of RLPS. CASE PRESENTATION A 55-year-old Caucasian female presented to the Emergency Department with a two-day history of abdominal pain, abdominal distension, inability to pass gas or stool, nausea, vomiting and lipothymia. Abdominal examination revealed abdominal distention, abdominal pain without obvious muscle guarding and a giant non-tender mass. Laboratory tests reported neutrophilic leukocytosis and anemia. Abdominal contrast-enhanced computed tomography (CECT) showed a heterogeneous and hypodense giant retroperitoneal mass compressing and displacing the surrounding organs and vessels. The patient underwent excision of a giant retroperitoneal mass. The postoperative course of the patient was uneventful. CLINICAL DISCUSSION RLPS is a malignant neoplasm that can slowly grow to enormous size with possible involvement of adjacent organs and vessels; it may recur locally and has a minimal capacity to metastasize. Preoperative diagnosis and staging of RLPS are important to establish appropriate management and prognosis. Surgery represents the gold standard for non-metastatic RLPS treatment. CONCLUSION RLPS is a rare malignant neoplasm generally difficult to detect early due to its late and nonspecific clinical presentation. CECT represents the most commonly used modality for diagnosis, staging and preoperative evaluation. Surgery represents the appropriate treatment of non-metastatic RLPS.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy.
| | - Riccardo Schillaci
- General Surgery Department, San Salvatore Hospital, Paternò (Catania), Italy
| | - Martina Reina
- General Surgery Department, San Salvatore Hospital, Paternò (Catania), Italy
| | | | - Maria D'Angelo
- General Surgery Department, San Salvatore Hospital, Paternò (Catania), Italy
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12
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Leporq B, Bouhamama A, Pilleul F, Lame F, Bihane C, Sdika M, Blay JY, Beuf O. MRI-based radiomics to predict lipomatous soft tissue tumors malignancy: a pilot study. Cancer Imaging 2020; 20:78. [PMID: 33115533 PMCID: PMC7594281 DOI: 10.1186/s40644-020-00354-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives To develop and validate a MRI-based radiomic method to predict malignancies in lipomatous soft tissue tumors. Methods This retrospective study searched in the database of our pathology department, data from patients with lipomatous soft tissue tumors, with histology and gadolinium-contrast enhanced T1w MR images, obtained from 56 centers with non-uniform protocols. For each tumor, 87 radiomic features were extracted by two independent observers to evaluate the inter-observer reproducibility. A reduction of learning base dimension was performed from reproducibility and relevancy criteria. A model was subsequently prototyped using a linear support vector machine to predict malignant lesions. Results Eighty-one subjects with lipomatous soft tissue tumors including 40 lipomas and 41 atypical lipomatous tumors or well-differentiated liposarcomas with fat-suppressed T1w contrast enhanced MR images available were retrospectively enrolled. Based on a Pearson’s correlation coefficient threshold at 0.8, 55 out of 87 (63.2%) radiomic features were considered reproducible. Further introduction of relevancy finally selected 35 radiomic features to be integrated in the model. To predict malignant tumors, model diagnostic performances were as follow: AUROC = 0.96; sensitivity = 100%; specificity = 90%; positive predictive value = 90.9%; negative predictive value = 100% and overall accuracy = 95.0%. Conclusion This work demonstrates that radiomics allows to predict malignancy in soft tissue lipomatous tumors with routinely used MR acquisition in clinical oncology. These encouraging results need to be further confirmed in an external validation population.
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Affiliation(s)
- Benjamin Leporq
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France.
| | | | - Frank Pilleul
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France.,Department of Radiology, CRLCC Léon Berard, Lyon, France
| | - Fabrice Lame
- Department of Radiology, CRLCC Léon Berard, Lyon, France
| | | | - Michael Sdika
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France
| | | | - Olivier Beuf
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France
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13
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Park JW, Jeong WG, Lee JE, Lee HJ, Ki SY, Lee BC, Kim HO, Kim SK, Heo SH, Lim HS, Shin SS, Yoon W, Jeong YY, Kim YH. Pictorial Review of Mediastinal Masses with an Emphasis on Magnetic Resonance Imaging. Korean J Radiol 2020; 22:139-154. [PMID: 32783412 PMCID: PMC7772375 DOI: 10.3348/kjr.2019.0897] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.
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Affiliation(s)
- Jin Wang Park
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyo Jae Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - So Yeon Ki
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yun Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
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14
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Melendez PE, Nguyen TT, Bhatt AA, Kaproth-Joslin K. Neoplastic pathology at the crossroads between neck imaging and cardiothoracic imaging. Insights Imaging 2020; 11:82. [PMID: 32643039 PMCID: PMC7343701 DOI: 10.1186/s13244-020-00879-2] [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: 12/18/2019] [Accepted: 04/24/2020] [Indexed: 11/10/2022] Open
Abstract
The thoracic inlet is located at the crossroads between imaging of the neck and the chest. Its location is an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many critical body systems, including the respiratory, lymphatic, neurologic, enteric, musculoskeletal, endocrine, and vascular systems, are located within this region. Neoplasms, both benign and malignant, can arise in any of the body systems located in this area. Due to the small size of this anatomic location, pathology is easily overlooked and imagers should be aware of the imaging appearance of these neoplasms, as well as which imaging modality is the most appropriate for neoplasm evaluation. This article will present an image rich, system-based discussion of the neoplastic pathology that can occur in this region. The anatomy of the thoracic inlet and the non-neoplastic pathology of the thoracic inlet have been covered in our companion article.
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Affiliation(s)
- Patricia E Melendez
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA.
| | - Trinh T Nguyen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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15
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Thinking beyond hernia: a review of non-hernia groin lumps. Abdom Radiol (NY) 2020; 45:1929-1949. [PMID: 31786622 DOI: 10.1007/s00261-019-02351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With increasing reliance on imaging, a large number of patients presenting with a groin lump are being referred to radiology to confirm the diagnosis of hernia, usually with an ultrasound in the first instance (occasionally MRI or CT). However, when imaging of the groin was performed, we have encountered many different kinds of non-hernia lesions in our practice. Such lesions can be categorized based on their tissue of origin and pathology. A specific diagnosis can often be reached using ultrasonography, MRI or a combination of imaging modalities. This review article will help general, musculoskeletal and abdominal radiologists to understand the anatomy of the groin, diagnose and characterise soft tissue lesions that may present as a groin lump, provide guidance for further imaging and insight into imaging features which may need specific investigations like core biopsy, tertiary referral and review at multidisciplinary meetings.
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16
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Kim BJ, Lee MS. Diaphragmatic liposarcoma with gall bladder invasion: CT and MRI findings. Radiol Case Rep 2020; 15:511-514. [PMID: 32140198 PMCID: PMC7044679 DOI: 10.1016/j.radcr.2020.01.036] [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: 12/29/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/18/2022] Open
Abstract
Primary liposarcoma originating from the diaphragm is an extremely rare case. Seventy-four-year-old male presented to emergency department with worsening right upper quadrant abdominal pain with dyspnea. Contrast-enhanced computed tomography of the abdomen demonstrated lobulated mass in right hemidiaphragm exhibiting mass effects to adjacent structures compressing gall bladder. Magnetic resonance imaging of the abdomen showed diaphragmatic mass with heterogeneous signal intensities with partial diffusion restriction. Surgical removal was performed and histology confirmed dedifferentiated liposarcoma arising from the diaphragm with gall bladder invasion.
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17
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Bajaj G, Tirumani H, Whisman MK, Raichandani S, Ram R, Jambhekar K, Gardner JM, Pandey T. Comprehensive Review of Abdominopelvic Mesenchymal Tumors with Radiologic Pathologic Correlation and Update on Current Treatment Guidelines - Part 1. Semin Ultrasound CT MR 2020; 41:222-238. [PMID: 32446433 DOI: 10.1053/j.sult.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies accounting for only 1% of all solid adult malignancies. These have been categorized in 12 broad groups by the World Health Organization (WHO) with their recent update in 2013. Majority of them lack specific imaging features serving as imaging conundrums for a radiologist. These are often large masses at presentation as they are asymptomatic or cause vague clinical symptoms. These tumors are challenging for surgeons as well as they find it difficult to achieve complete resection because of complex intra-abdominal anatomy and their close relationship with critical structures. Often, a multidisciplinary approach is required to decide on the most appropriate management for these complex cases so as to provide optimal patient care. Knowledge of the WHO classification, pathologic features and available treatment options will help the radiologist make a meaningful contribution in multidisciplinary discussions of such cases and overall patient care. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor are the 3 most common primary intra-abdominal sarcomas. In part 1 of this article, general features of soft tissue sarcomas and some of the common tumors from WHO category 1-4 found in abdomen and pelvis are discussed. Part 2 will focus on common tumors from remainder of the WHO categories.
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Affiliation(s)
- Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Harika Tirumani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michella K Whisman
- Department of Pathology and Clinical Laboratories, University of Michigan, Ann Arbor, MI
| | - Surbhi Raichandani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kedar Jambhekar
- Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jerad M Gardner
- Department of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology and Orthopedics, University of Arkansas for Medical Sciences, Little Rock, AR
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18
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Incidental dedifferentiated mediastinal liposarcoma on F-18-fluciclovine PET/CT. Clin Imaging 2020; 59:21-24. [DOI: 10.1016/j.clinimag.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
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19
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Yun JS, Chung HW, Song JS, Lee SH, Lee MH, Shin MJ. Dedifferentiated liposarcoma of the musculoskeletal system: expanded MR imaging spectrum from predominant fatty mass to non-fatty mass. Acta Radiol 2019; 60:1474-1481. [PMID: 30907094 DOI: 10.1177/0284185119833060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jae Sung Yun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Myung Jin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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20
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Mujtaba B, Wang F, Taher A, Aslam R, Madewell JE, Nassar S. Myxoid Liposarcoma With Skeletal Metastases: Pathophysiology and Imaging Characteristics. Curr Probl Diagn Radiol 2019; 50:66-73. [PMID: 31813645 DOI: 10.1067/j.cpradiol.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022]
Abstract
Liposarcoma is a commonly occurring soft tissue sarcoma that can be divided into 4 subtypes. Myxoid and round cell liposarcoma (MRCL) represent one of these subtypes and are classified together due to their shared chromosomal translocation. Histologic analysis of MRCL reveals a myxoid matrix with a delicate capillary network and dispersed lipoblasts. Varying degrees of round cell component are also observed, with greater amounts of round cells indicating a higher histologic grade and poorer prognosis. MRCL has a unique pattern of spread due to its initial tendency to spread to extrapulmonary sites. Additionally, skeletal metastases are frequently found in cases of MRCL. While various imaging techniques are used to visualize MRCL and metastases, magnetic resonance imaging is generally the preferred method. This article reviews the pathophysiology and imaging features of MRCL as well as the imaging characteristics, advantages, and drawbacks of multiple imaging modalities for visualizing bone metastases.
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Affiliation(s)
- Bilal Mujtaba
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Felicia Wang
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ahmed Taher
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rizwan Aslam
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sameh Nassar
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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21
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Naghavi AO, Yang GQ, Latifi K, Gillies R, McLeod H, Harrison LB. The Future of Radiation Oncology in Soft Tissue Sarcoma. Cancer Control 2018. [PMCID: PMC6291881 DOI: 10.1177/1073274818815504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy (RT) is an important component of the treatment of soft tissue sarcomas (STS) and has been traditionally incorporated with a homogenous approach despite the reality that STS displays a known heterogeneity in clinicopathologic features and treatment outcomes. In this article, we explore the principle components of personalized medicine, including genomics, radiomics, and treatment response, along with their impact on the future of radiation therapy for STS. We propose a shift in the treatment paradigm for STS from a one-size-fits-all technique to one that implements the tenets of personalized medicine and includes the framework for a potential clinical trial technique in this heterogeneous disease.
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Affiliation(s)
- Arash O. Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- These authors contributed equally to this work
| | - George Q. Yang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- These authors contributed equally to this work
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Robert Gillies
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Howard McLeod
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Louis B. Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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22
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Sun XL, Wen K, Xu ZZ, Wang XP. Magnetic resonance imaging findings for differential diagnosis of perianal plexiform schwannoma: Case report and review of the literature. World J Clin Cases 2018; 6:88-93. [PMID: 29774221 PMCID: PMC5955733 DOI: 10.12998/wjcc.v6.i5.88] [Citation(s) in RCA: 2] [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: 01/15/2018] [Revised: 03/04/2018] [Accepted: 04/01/2018] [Indexed: 02/05/2023] Open
Abstract
Plexiform schwannoma is an extremely rare variant of schwannoma, accounting for approximately 5% of cases. Due to the rarity and lack of typical symptoms, signs and radiological images, a definite diagnosis of plexiform schwannoma may not be made by clinicians prior to biopsy. In the present study, we report the first case (to our knowledge) of perianal plexiform schwannoma arising from the overlapped skin of the ischioanal fossa, and we propose an intratumorally nonenhanced circumferential capsule dividing the tumour into multiple homogeneously enhanced nodules as a magnetic resonance imaging feature to aid in the differential diagnosis of plexiform schwannoma from ancient schwannoma, cavernous haemangioma, liposarcoma and plexiform neurofibroma.
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Affiliation(s)
- Xue-Liang Sun
- Department of Colorectal Surgery, the Suzhou Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou 215000, Jiangsu Province, China
| | - Ke Wen
- Department of Colorectal Surgery, the Suzhou Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Zhong Xu
- Department of Colorectal Surgery, the Suzhou Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou 215000, Jiangsu Province, China
| | - Xiao-Peng Wang
- Department of Colorectal Surgery, the Suzhou Affiliated Hospital of Nanjing University of Chinese Medicine, Suzhou 215000, Jiangsu Province, China
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23
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Jagannathan JP, Tirumani SH, Ramaiya NH. Imaging in Soft Tissue Sarcomas: Current Updates. Surg Oncol Clin N Am 2018; 25:645-75. [PMID: 27591491 DOI: 10.1016/j.soc.2016.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) are heterogeneous malignant tumors that have nonspecific imaging features. A combination of clinical, demographic, and imaging characteristics can aid in the diagnosis. Imaging provides important information regarding the tumor extent, pretreatment planning, and surveillance of patients with STS. In this article, we illustrate the pertinent imaging characteristics of the commonly occurring STS and some uncommon sarcomas with unique imaging characteristics.
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Affiliation(s)
- Jyothi P Jagannathan
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Sree Harsha Tirumani
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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24
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Rosenberg M, Groth JV, Taljanovic MS, Mar WA. Myxoid-round cell liposarcoma: MRI appearance after radiation therapy and relationship to response. Radiol Case Rep 2018; 12:811-814. [PMID: 29484077 PMCID: PMC5823305 DOI: 10.1016/j.radcr.2017.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022] Open
Abstract
Liposarcomas are classified into 4 different subtypes, with the myxoid-round cell variant demonstrating increased morbidity and metastatic potential dependent on cell composition. Unique to sarcomas, the myxoid-round cell liposarcoma is remarkably sensitive to radiation therapy in the pretreatment setting, owing to the tumor morphology and vascular distribution. Herein we report a case of myxoid-round cell liposarcoma within the deep soft tissues of the thigh of an 81-year-old male with excellent neoadjuvant response to radiation. We briefly review treatment options.
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Affiliation(s)
- Michael Rosenberg
- Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, Suite 2600, Chicago, IL 60612
| | - John V Groth
- Department of Pathology, University of Illinois Hospital & Health Sciences System, Third Floor, 1740 W. Taylor St., Chicago, IL 60612
| | - Mihra S Taljanovic
- Department of Medical Imaging, College of Medicine, Banner- University Medical Center, University of Arizona, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724
| | - Winnie A Mar
- Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, Suite 2600, Chicago, IL 60612
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25
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Coran A, Ortolan P, Attar S, Alberioli E, Perissinotto E, Tosi AL, Montesco MC, Rossi CR, Tropea S, Rastrelli M, Stramare R. Magnetic Resonance Imaging Assessment of Lipomatous Soft-tissue Tumors. ACTA ACUST UNITED AC 2018; 31:387-395. [PMID: 28438867 DOI: 10.21873/invivo.11071] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 01/13/2023]
Abstract
AIM To establish the accuracy of magnetic resonance imaging (MRI) in distinguishing between benign and malignant lipomatous tumors; to evaluate the reproducibility of the MRI interpretation assessing the agreement between judgments of two radiologists with the same experience in soft-tissue sarcomas; to identify an association among MRI findings (size, depth, septa, nodules, signal homogeneity) and nature of the lesion. MATERIALS AND METHODS A total of 54 patients (28 men and 26 women), with a mean age of 56 (range=27-84) were included years. All subjects followed-up by the Multidisciplinary Sarcoma Group. The following MRI findings were judged in a blind study by two radiologists: size, localization, septa, nodules and signal homogeneity. A diagnostic indication was then given from among lipoma, atypical lipomatous tumour (ALT) and liposarcoma. Accuracy in distinguishing between benign and malignant lesions, and between lipoma and ALT (Fisher's exact test), inter-operator agreement (Cohen's kappa), association of MRI findings and malignancy of the lesion (Fisher's exact test and odds ratio) were evaluated. RESULTS The inter-operator agreement was complete (100%). The agreement between diagnostic hypothesis and histological diagnosis was statistically significant (p<0.05). Among the radiological findings taken into account, only septa and signal homogeneity were significantly associated with the malignancy of the lesion (p<0.05). CONCLUSION MRI could be helpful in distinguishing lipomatous tumors, allowing biopsy to be avoided in some cases (negative predictive value=100%).
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Affiliation(s)
- Alessandro Coran
- Department of Radiology and Medical Physics, Oncologic Radiology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Paolo Ortolan
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
| | - Shady Attar
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
| | - Enrico Alberioli
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
| | - Egle Perissinotto
- Department of Biostatistics, Public Health Unit, University of Padova, Padua, Italy
| | - Anna Lisa Tosi
- Department of General Health Services, Pathology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Maria Cristina Montesco
- Department of General Health Services, Pathology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Carlo Riccardo Rossi
- Department of Surgical Oncology, Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Saveria Tropea
- Department of Surgical Oncology, Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Marco Rastrelli
- Department of Surgical Oncology, Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Roberto Stramare
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
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26
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Rosato L, Panier Suffat L, Bertotti L, Perino P, Comello E, Mondini G. Retroperitoneal or mesenteric primary liposarcoma: clinical and prognostic evaluations on five cases. G Chir 2018; 39:57-62. [PMID: 29549683 PMCID: PMC5902147 DOI: 10.11138/gchir/2018.39.1.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Retroperitoneal or mesenteric primary liposarcoma is a malignant neoplasia whose prognosis depends on the biological variants, the radical resection surgery and the histological subtypes, as well as on local and remote recurrences. Liposarcoma is the most common variant of this tumour among tumours of soft retroperitoneal tissue. The purpose of this study is to evaluate whether the treatment of this disease, carried out at the Ivrea Hospital for urgent reasons, may be considered in line with the experience of high-volume Centres. PATIENTS AND METHODS Between 1982 and 2016 five patients were hospitalized with a diagnosis of acute abdomen due to retroperitoneal or mesenteric primary liposarcoma: one myxoid of the mesentery, one well-differentiated of lesser epiploon, one well-differentiated of mesentery, and two dedifferentiates of the retroperitoneum. RESULTS The five patients, all males, had a average age of 59 years (range 48-86) and were all subjected to general anaesthesia and open technique for total tumour removal. Only the patient with the myxoid liposarcoma had two recurrences. All are alive and healthy after a follow-up of 177 months (range 9-420). CONCLUSION These tumours should be removed radically, if necessary in conjunction with contiguous organs. Rarity and therapeutic complexity require a treatment, sometimes even multimodal, in highvolume centres. Patients admitted in General Surgery Unit for unpostponable urgency should be operated by surgeons experienced in the treatment of abdominal disease to achieve survival results in line to those achievable in Hub Centres.
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Noh D, Choi W, Son W, Lee M, Park S, Lee K. Liposarcoma of the spermatic cord in a Toy Poodle. J Vet Med Sci 2017; 79:2026-2029. [PMID: 29142149 PMCID: PMC5745184 DOI: 10.1292/jvms.17-0357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Liposarcoma of the spermatic cord is extremely rare in dogs and humans. This report describes the clinical signs, typical diagnostic imaging including ultrasound and computed tomography, and treatment of a liposarcoma of the spermatic cord of a Toy Poodle confirmed by histological examination after a surgical procedure. This case highlights the importance of preoperative diagnostic imaging and histopathological examination in dogs with an inguinal or scrotal mass.
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Affiliation(s)
- Daji Noh
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Wooson Choi
- Two Man Veterinary Hospital, Daegu 42770, Korea
| | - Woochan Son
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Manhee Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Seungchun Park
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Kija Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
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De La Hoz Polo M, Dick E, Bhumbra R, Pollock R, Sandhu R, Saifuddin A. Surgical considerations when reporting MRI studies of soft tissue sarcoma of the limbs. Skeletal Radiol 2017; 46:1667-1678. [PMID: 28884363 DOI: 10.1007/s00256-017-2745-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
Soft tissue sarcomas (STS) are rare tumours that require prompt diagnosis and treatment at a specialist centre. Magnetic resonance imaging (MRI) has become the modality of choice for identification, characterisation, biopsy planning and staging of soft tissue masses. MRI enables both the operating surgeon and patient to be optimally prepared prior to surgery for the likelihood of margin-negative resection and to anticipate possible sacrifice of adjacent structures and consequent loss of function. The aim of this review is to aid the radiologist in performing and reporting MRI studies of soft tissue sarcomas, with particular reference to the requirements of the surgical oncologist.
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Affiliation(s)
- Marcela De La Hoz Polo
- Radiology Department, Kings College Hospital, Denmark Hill, London, Brixton, SE5 9RS, UK.
| | - Elizabeth Dick
- Radiology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - Rej Bhumbra
- Trauma & Orthopaedic Department, Barts Health Orthopaedic Centre, Newham & The Royal London Hospitals, Whitechapel Rd, London, Whitechapel, E1 1BB, UK
| | - Rob Pollock
- Trauma & Orthopaedic Department, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ranbir Sandhu
- Radiology Department, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Asif Saifuddin
- Radiology Department, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
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Virágh KA, Cherneykin S, Oommen R, Shafaee Z. Primary liposarcoma of the diaphragm: a rare intra-abdominal mass. Radiol Case Rep 2017; 12:136-140. [PMID: 28228897 PMCID: PMC5310257 DOI: 10.1016/j.radcr.2016.11.001] [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: 10/16/2016] [Accepted: 11/01/2016] [Indexed: 11/21/2022] Open
Abstract
Primary malignant tumors of the diaphragm are rare, and primary liposarcoma of the diaphragm is extremely rare. The role of imaging is description of the anatomic relationships of the tumor as well as a suggestion of histologic diagnosis based on the presence of fatty and/or nonfatty components.
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Affiliation(s)
- Károly András Virágh
- Department of Radiology, Columbia University, NewYork-Presbytarian/Lawrence Hospital Center, 55 Palmer Road, Bronxville, NY 10708, USA
| | - Sergey Cherneykin
- Department of Pathology, Columbia University, NewYork-Presbytarian/Lawrence Hospital Center, Bronxville, NY, USA
| | - Roy Oommen
- Department of Surgery, Columbia University, NewYork-Presbytarian/Lawrence Hospital Center, Bronxville, NY, USA
| | - Zahra Shafaee
- Department of Surgery, Columbia University, NewYork-Presbytarian/Lawrence Hospital Center, Bronxville, NY, USA
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Primary Extremity Liposarcoma: MRI Features, Histopathology, and Clinical Outcomes. J Comput Assist Tomogr 2017; 40:791-8. [PMID: 27224232 DOI: 10.1097/rct.0000000000000431] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to describe magnetic resonance imaging (MRI) features of extremity liposarcoma (LPS) subtypes, correlating with histopathology and clinical outcomes. METHODS In this retrospective study, we included 125 patients (80 men, 45 women; mean age, 53 years) with extremity LPS [23 atypical lipomatous tumor (ALT), 9 dedifferentiated (DDLPS), 70 myxoid (MLPS), 23 pleomorphic (PLPS)]. Pretreatment MRI of primary tumors in 56 patients (10 ALT, 4 DDLPS, 28 MLPS, 14 PLPS) was reviewed. RESULTS All subtypes were predominantly T1 isointense relative to skeletal muscle (DDLPS = 3/4, MLPS = 28/28, PLPS = 13/14) and T2 hyperintense (ALT = 10/10, DDLPS = 3/4, MLPS = 28/28, PLPS = 14/14) except for ALT which were T1 hyperintense (8/10). Within MLPS, high grade was associated with unencapsulated margins (P = 0.05) and solid, nodular enhancement (P < 0.0001). Peritumoral edema (P = 0.03) and T2 heterogeneity (P = 0.05) predicted pulmonary (rather than extrapulmonary) metastases in MLPS. Tumor subtype correlated with mortality (P = 0.04). CONCLUSIONS The MRI features can help to distinguish between extremity LPS subtypes, and can predict histopathologic grade and metastatic pattern in myxoid LPS.
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Baheti AD, Jagannathan JP, O'Neill A, Tirumani H, Tirumani SH. Current Concepts in Non-Gastrointestinal Stromal Tumor Soft Tissue Sarcomas: A Primer for Radiologists. Korean J Radiol 2017; 18:94-106. [PMID: 28096721 PMCID: PMC5240485 DOI: 10.3348/kjr.2017.18.1.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/07/2016] [Indexed: 12/26/2022] Open
Abstract
Non-gastrointestinal stromal tumor (GIST) soft tissue sarcomas (STSs) are a heterogeneous group of neoplasms whose classification and management continues to evolve with better understanding of their biologic behavior. The 2013 World Health Organization (WHO) has revised their classification based on new immunohistochemical and cytogenetic data. In this article, we will provide a brief overview of the revised WHO classification of soft tissue tumors, discuss in detail the radiology and management of the two most common adult non-GIST STS, namely liposarcoma and leiomyosarcoma, and review some of the emerging histology-driven targeted therapies in non-GIST STS, focusing on the role of the radiologist.
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Affiliation(s)
- Akshay D Baheti
- Department of Radiology, Tata Memorial Centre, Mumbai 400012, India
| | - Jyothi P Jagannathan
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.; Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ailbhe O'Neill
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.; Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Harika Tirumani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.; Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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Child JR, Young CR, Amini B. Liposarcoma of the thigh with mixed calcification and ossification. Radiol Case Rep 2016; 11:217-21. [PMID: 27594953 PMCID: PMC4996926 DOI: 10.1016/j.radcr.2016.05.010] [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: 04/23/2016] [Revised: 05/11/2016] [Accepted: 05/20/2016] [Indexed: 02/07/2023] Open
Abstract
Liposarcoma is one of the most common soft-tissue sarcomas. Calcification and ossification can occur in liposarcoma; however, the presence of both ossification and calcification is a very rare entity. We present a case of a partially calcified and ossified dedifferentiated liposarcoma of the thigh in a 76-year-old woman, which contained heterologous elements of chondrosarcoma and rhabdomyosarcoma.
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Affiliation(s)
- Jeremy R Child
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1475, Houston, TX 77030, USA
| | - Colin R Young
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Behrang Amini
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1475, Houston, TX 77030, USA
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Rizer M, Singer AD, Edgar M, Jose J, Subhawong TK. The histological variants of liposarcoma: predictive MRI findings with prognostic implications, management, follow-up, and differential diagnosis. Skeletal Radiol 2016; 45:1193-204. [PMID: 27209201 DOI: 10.1007/s00256-016-2409-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/01/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
Liposarcoma is the single most common soft tissue sarcoma accounting for up to 35 % of sarcomas. It represents a histologically diverse group of soft tissue tumors that demonstrate a wide range of imaging appearances with varied behavior patterns. Correspondingly, more aggressive histological subtypes often require management that includes a combination of surgery, chemotherapy, and radiation therapy. Distinguishing among liposarcoma subtypes has important therapeutic and prognostic implications. In this manuscript, we review the liposarcoma subtypes and their histologic and MRI findings, prognostic implications, and differential diagnostic considerations.
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Affiliation(s)
- Magda Rizer
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory Healthcare, Atlanta, GA, USA
| | - Mark Edgar
- Bone and Soft Tissue Pathology, Department of Pathology, Emory Healthcare, Atlanta, GA, USA
| | - Jean Jose
- Section of Musculoskeletal Imaging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ty K Subhawong
- Section of Musculoskeletal Imaging, Miller School of Medicine, University of Miami, Miami, FL, USA
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Morris CJ, Younan Y, Singer AD, Johnson G, Chamieh J, Datir A. Masses of the hand and wrist, a pictorial review. Clin Imaging 2016; 40:650-65. [DOI: 10.1016/j.clinimag.2016.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 01/07/2023]
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Soft-Tissue Sarcomas: An Update for Radiologists Based on the Revised 2013 World Health Organization Classification. AJR Am J Roentgenol 2016; 206:924-32. [PMID: 26998884 DOI: 10.2214/ajr.15.15498] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Soft-tissue sarcomas are a diverse group of malignancies, and our rapidly improving understanding of their molecular pathogenesis and treatment is leading to better clinical outcomes. The revised 2013 World Health Organization (WHO) classification of soft-tissue sarcomas introduced several important changes. We provide a comprehensive overview of the relevant changes for radiologists. CONCLUSION Rapid advances in the understanding of the pathogenesis and molecular biology of soft-tissue sarcomas led to major revisions in the 2013 WHO classification. To provide optimal multidisciplinary patient care, radiologists must remain up-to-date with the latest developments in the field of soft-tissue sarcomas to best correlate the histologic and imaging features of the various types of tumors and understand the unique patterns of treatment response and disease recurrence.
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36
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Davis DL, Vachhani P. Traumatic Extra-capsular and Intra-capsular Floating Fat: Fat-fluid Levels of the Knee Revisited. J Clin Imaging Sci 2015; 5:60. [PMID: 26713176 PMCID: PMC4683790 DOI: 10.4103/2156-7514.170729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/30/2015] [Indexed: 11/08/2022] Open
Abstract
Floating fat is a sign of acute bone injury at the knee following trauma. The goal of this article is to review the etiology, patterns, and mimickers of extra-capsular and intra-capsular floating fat, with the major emphasis on knee trauma in the acute setting. We will discuss the spectrum of multimodal imaging findings for rare presentations of extra-capsular floating fat, and contrast these with common and atypical forms of intra-capsular lipohemarthrosis, as an aid to the assessment of acute bone trauma at the knee.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Prasann Vachhani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Myxoid soft-tissue neoplasms: comprehensive update of the taxonomy and MRI features. AJR Am J Roentgenol 2015; 204:374-85. [PMID: 25615761 DOI: 10.2214/ajr.14.12888] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The purpose of this article is to review the classification, clinical presentation, and histopathologic and MRI features of myxoid soft-tissue neoplasms. CONCLUSION. MRI is the modality of choice for characterization of myxoid soft-tissue tumors. A combination of imaging features (including certain characteristic signs), clinical features, and patient demographics can help the radiologist in coming to a specific diagnosis or in narrowing down the differential diagnoses.
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Gao W, Wang H, Liu J, Wang F, Dong J, Geng J. Multiple mesenteric well-differentiated liposarcoma complicated by purulent inflammation: A case report. Oncol Lett 2015; 9:1333-1336. [PMID: 25663908 PMCID: PMC4315053 DOI: 10.3892/ol.2015.2847] [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: 05/18/2014] [Accepted: 12/02/2014] [Indexed: 11/05/2022] Open
Abstract
Multiple mesenteric well-differentiated (WD) liposarcoma is an extremely rare entity. The present study describes a case of multiple mesenteric WD liposarcoma, complicated by purulent inflammation, in a 59-year-old male who presented with abdominal pain and pyrexia of unknown origin. A computed tomography scan of the abdomen revealed a large, non-encapsulated mass in the abdomino-pelvic cavity, which was characterized by two components, a main portion of fatty density and a non-adipose solid portion. A re-evaluated CT scan, performed eight days later, revealed an enlargement of the non-adipose mass. A laparotomy was performed, and numerous separated fatty nodules and masses of various sizes were identified within the mesentery of the small intestine. The histological findings were consistent with an adipocytic subtype of multiple mesenteric WD liposarcoma, with the largest of the tumors complicated by purulent inflammation. The multiplicity of these tumors and the concurrent purulent inflammation in the present case make it unique.
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Affiliation(s)
- Wei Gao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Huaizhou Wang
- Department of Surgery, Yantai Kouqiang Hospital, Yantai, Shandong 264000, P.R. China
| | - Jinyu Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Fujiang Wang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Jianjun Dong
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Junzu Geng
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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Metastasis in dedifferentiated liposarcoma: Predictors and outcome in 148 patients. Eur J Surg Oncol 2015; 41:899-904. [PMID: 25659772 DOI: 10.1016/j.ejso.2015.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/30/2014] [Accepted: 01/13/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe the pattern of dedifferentiated liposarcoma (DDLPS) metastases and to analyze their predictors and outcome. MATERIALS AND METHODS In this retrospective study, we reviewed the imaging and clinical records of all consenting patients with histopathology-confirmed DDLPS seen from 2000 through 2012. The predictive value of clinical and histopathologic parameters for metastasis later in the disease course was analyzed using univariate and multivariate analyses. Survival of patients with and without metastasis was compared using Log-rank test. RESULTS Records of 148 patients (57 women, 91 men; mean age 59 years, range 30-87 years) were reviewed. Distant metastases were observed in 44/148 patients (29.7%), 9/44 (20.5%) at presentation and 35/44 (79.5%) developing them later at a median interval of 8 months (IQR = 0.80-26 months). Median duration of follow-up was 38 months (IQR = 18-74 months) with 77/148 patients (31 with metastases) deceased at the time of analysis. Median survival was 28 months (IQR = 10-56 months) for patients with metastases and 38 months (IQR, 17-65 months) for patients without metastases (p = 0.0123, Log-Rank test; Hazard ratio 1.79 [95% confidence interval 1.11-2.84]). Lung was the most common site of metastases (33 patients, 22.3%). On univariate analysis, grade and local recurrence were associated with subsequent risk of metastasis where as age, tumor size, site, de novo dedifferentiation, number of previous surgical resections, margin positivity and chemoradiation were not. On multivariate analysis, high tumor grade (p-value = 0.0005, OR 5.05; 95% CI 2.01-13.48) and local recurrence (p-value = 0.0025, OR 4.46; 95% CI 1.67-13.40) predicted metastasis. CONCLUSION Lung was most frequent site of DDLPS metastases. Risk of developing metastatic disease was statistically associated with tumor grade and local recurrence. Metastatic disease was associated with decreased survival.
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Senapati GM, Sheiman RG, Almashat S, Goldsmith JD. Pleomorphic liposarcoma of the inferior vena cava. Radiographics 2015; 35:269-74. [PMID: 25590403 DOI: 10.1148/rg.351140198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gunjan M Senapati
- From the Departments of Radiology (G.M.S., R.G.S.) and Pathology (S.A., J.D.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
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Baheti AD, Tirumani SH, Sewatkar R, Shinagare AB, Hornick JL, Ramaiya NH, Jagannathan JP. Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients. Br J Radiol 2014; 88:20140608. [PMID: 25431890 DOI: 10.1259/bjr.20140608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To study the appearance of primary and metastatic extremity synovial sarcoma (SS) on cross-sectional imaging. METHODS In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, the imaging features of 78 patients (42 males and 36 females; mean age, 40 years) with primary and metastatic extremity SS on MRI and multidetector CT were reviewed, with baseline MRI of the primary available in 31 patients. RESULTS Primary SSs were predominantly well-circumscribed (27/31) and heterogeneously enhancing solid (18/31) or solid-cystic (13/31) tumours. Imaging features visualized included the presence of perilesional oedema (14/31), interfascial (15/31) and intercompartmental extension (7/31), triple sign (11/31), intratumoral haemorrhage (10/31), calcification (6/31), bowl of grapes appearance (5/31) and bone involvement (3/31). Smaller T1 stage tumours (8/31) appeared as heterogeneously enhancing lesions, with some lesions demonstrating interfascial and intercompartmental extension and perilesional oedema. Recurrent/metastatic disease developed in 49/78 (63%) patients. Of these, 20/78 (26%) had metastasis at presentation, while the remaining developed metastatic disease at a median interval of 27 months (range, 3-161 months). Pleuropulmonary metastases (46/78) were the most common sites, with most of the metastases being pleural based. On univariate analysis, larger tumour size, the presence of perilesional oedema, intercompartmental extension, the presence of intralesional haemorrhage and bowl of grapes appearance on MRI were associated with a significantly higher incidence of metastatic disease. CONCLUSION Certain imaging features of primary SS predict the risk of development of metastatic disease. Imaging features of T1 stage tumours included heterogeneous enhancement, interfascial extension and perilesional oedema. Pleural-based metastases are commonly seen in SSs. ADVANCES IN KNOWLEDGE Imaging features of primary SS correlate with metastatic disease. Pleural-based metastases are often present in SSs.
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Affiliation(s)
- A D Baheti
- 1 Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Tirumani SH, Wagner AJ, Tirumani H, Shinagare AB, Jagannathan JP, Hornick JL, George S, Ramaiya NH. Is the nonlipomatous component of dedifferentiated liposarcoma always soft tissue on CT? Analysis of CT densities and correlation with rate of growth in 60 patients. ACTA ACUST UNITED AC 2014; 40:1248-54. [DOI: 10.1007/s00261-014-0267-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Primary malignant tumors of peritoneal and retroperitoneal origin: clinical and imaging features. Surg Oncol Clin N Am 2014; 23:821-45. [PMID: 25246051 DOI: 10.1016/j.soc.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peritoneal carcinomatosis and metastatic involvement of the retroperitoneum are manifestations of many organ-based malignancies and lymphoproliferative disorders. Primary malignancies of peritoneal and retroperitoneal origin occur much less frequently, and are difficult to distinguish from metastatic disease on imaging alone. However, the imaging features of these primary tumors, taken in concert with the clinical data, can be helpful in narrowing the scope of the differential diagnosis. This review presents the clinical and imaging features of primary peritoneal and retroperitoneal tumors arising from the various tissue components that comprise the ligaments, mesenteries, and connective tissues of the peritoneal and retroperitoneal spaces.
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Can Experienced Observers Differentiate between Lipoma and Well-Differentiated Liposarcoma Using Only MRI? Sarcoma 2013; 2013:982784. [PMID: 24385845 PMCID: PMC3872425 DOI: 10.1155/2013/982784] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/28/2013] [Accepted: 11/04/2013] [Indexed: 12/14/2022] Open
Abstract
Well-differentiated liposarcoma represents a radiographic diagnostic dilemma. To determine the accuracy, interrater reliability, and relationship of stranding, nodularity, and size in the MRI differentiation of lipoma and well-differentiated liposarcoma, MRI scans of 60 patients with large (>5 cm), deep, pathologically proven lipomas or well-differentiated liposarcomas were examined by 10 observers with subspecialty training blinded to diagnosis. Observers indicated whether the amount of stranding, nodularity, and size of each tumor suggested a benign or malignant diagnosis and rendered a diagnosis of lipoma or well-differentiated liposarcoma. The accuracy, reliability, and relationship of stranding, nodularity, and size to diagnosis were calculated for all samples. 69% of reader MRI diagnoses agreed with final pathology diagnosis (95% CI 65–73%). Readers tended to err choosing a diagnosis of liposarcoma, correctly identifying lipomas in 63% of cases (95% CI 58–69%) and liposarcomas in 75% of cases (95% CI 69–80%). Assessment of the relationship of stranding, nodularity, and size to correct diagnosis showed that the presence of each was associated with a decreased likelihood of a lipoma pathological diagnosis (P < 0.01). While the radiographic diagnosis of lipoma or well-differentiated liposarcoma cannot be made with 100% certainty, experienced observers have a 69% chance of rendering a correct diagnosis.
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Ayyappan AP, Crystal P, Torabi A, Foley BJ, Fornage BD. Imaging of fat-containing lesions of the breast: a pictorial essay. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:424-433. [PMID: 23836049 DOI: 10.1002/jcu.22070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/22/2013] [Indexed: 06/02/2023]
Abstract
Fat-containing breast lesions constitute a heterogeneous group of predominantly benign tumors and non-neoplastic conditions. The role of imaging is to distinguish leave-me-alone lesions from rarely occurring malignant fat-containing tumors that require histologic analysis. Correlating mammographic findings with appearance at ultrasonography often helps in identifying lesions that do not require further work-up. MRI can be valuable to confirm the presence of fat and characterize lesions indeterminate on conventional imaging. The purpose of this multimodality imaging review is to exemplify the radiologic appearances of common and uncommon fat-containing breast lesions to facilitate accurate diagnosis, avoid unnecessary interventions, and ensure appropriate management.
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Affiliation(s)
- Anoop Padoor Ayyappan
- Department of Radiology, 4800 Alberta Avenue, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso, Texas 79905, USA
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Tirumani SH, Jagannathan JP, O'Regan K, Kim KW, Shinagare AB, Krajewski KM, Ramaiya NH. Molecular targeted therapies in non-GIST soft tissue sarcomas: what the radiologist needs to know. Cancer Imaging 2013; 13:197-211. [PMID: 23649384 PMCID: PMC3645342 DOI: 10.1102/1470-7330.2013.0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2013] [Indexed: 12/30/2022] Open
Abstract
Non-gastrointestinal stromal soft tissue sarcomas are uncommon neoplasms that have a dismal prognosis due to a high incidence of metastases and a poor response to conventional chemotherapy. The identification of characteristic genetic alterations in several of these tumors has opened the window for molecular targeted therapies in patients who have failed conventional chemotherapy. Imaging plays a critical role in assessing the response to these novel therapeutic agents. Just like the response of gastrointestinal stromal tumors to imatinib, the response of non-gastrointestinal stromal soft tissue sarcomas to molecular targeted drugs is better evaluated on imaging by alternate tumor response criteria such as the Choi criteria. In addition, these drugs are associated with distinct class-specific drug toxicities that can come to attention for the first time on imaging. The purpose of this article is to provide a primer for the radiologist on the various molecular targeted therapies in advanced/metastatic non-gastrointestinal stromal soft tissue sarcomas with emphasis on the role of imaging in assessing treatment response and complications.
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Affiliation(s)
- Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
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