Abstract:Numerous neurogenic tumors can affect the musculoskeletal system, including traumatic neuroma, Morton neuroma, neural fibrolipoma, nerve sheath ganglion, neurilemoma, neurofibroma, and malignant peripheral nerve sheath tumors (PNSTs). The diagnosis of neurogenic tumors can be suggested from their imaging appearances, including lesion shape and intrinsic imaging characteristics. It is also important to establish lesion location along a typical nerve distribution (eg, plantar digital nerve in Morton neuroma, med… Show more
“…On MR imaging, superficial neurofibromas tend to be asymmetric, lack fascicular morphology and target-like signal intensity, and are likely to involve skin [34], features that are evident in our case (Fig. 11).…”
Section: Intermediate-grade Lesionsmentioning
confidence: 79%
“…They are hypo- to isointense to muscle on T1w sequence and heterogeneously hyperintense on T2w sequence [35, 36]. Neurofibromas have a propensity for recurrence as complete resection, which would require sacrificing the whole nerve, is usually not possible [34]. Fig.…”
Focal hand lesions are commonly encountered in clinical practice and are often benign. Magnetic resonance (MR) imaging is the imaging modality of choice in evaluating these lesions as it can accurately determine the nature of the lesion, enhancement pattern and exact location in relation to surrounding tissues. However, while MR features of various soft tissue lesions in the hand have been well described, it is often still difficult to differentiate between benign and malignant lesions. We review the MR imaging features of a variety of focal hand lesions presenting at our institution and propose a classification into “benign”, “intermediate grade” (histologically benign but locally aggressive with potential for recurrence) and frankly “malignant” lesions based on MR findings. This aims to narrow down differential diagnoses and helps in further management of the lesion, preoperative planning and, in cases of primary malignancy, local staging.Teaching Points• Hand lesions are often benign and MR is essential as part of the workup.• MR features of various hand lesions are well described but are often non-specific.• Certain MR features may help for the diagnosis but histological examination is usually required.• We aim to classify hand lesions based on MR features such as margin, enhancement and bony involvement.• Classifying these lesions can help narrow down differential diagnoses and aid management.
“…On MR imaging, superficial neurofibromas tend to be asymmetric, lack fascicular morphology and target-like signal intensity, and are likely to involve skin [34], features that are evident in our case (Fig. 11).…”
Section: Intermediate-grade Lesionsmentioning
confidence: 79%
“…They are hypo- to isointense to muscle on T1w sequence and heterogeneously hyperintense on T2w sequence [35, 36]. Neurofibromas have a propensity for recurrence as complete resection, which would require sacrificing the whole nerve, is usually not possible [34]. Fig.…”
Focal hand lesions are commonly encountered in clinical practice and are often benign. Magnetic resonance (MR) imaging is the imaging modality of choice in evaluating these lesions as it can accurately determine the nature of the lesion, enhancement pattern and exact location in relation to surrounding tissues. However, while MR features of various soft tissue lesions in the hand have been well described, it is often still difficult to differentiate between benign and malignant lesions. We review the MR imaging features of a variety of focal hand lesions presenting at our institution and propose a classification into “benign”, “intermediate grade” (histologically benign but locally aggressive with potential for recurrence) and frankly “malignant” lesions based on MR findings. This aims to narrow down differential diagnoses and helps in further management of the lesion, preoperative planning and, in cases of primary malignancy, local staging.Teaching Points• Hand lesions are often benign and MR is essential as part of the workup.• MR features of various hand lesions are well described but are often non-specific.• Certain MR features may help for the diagnosis but histological examination is usually required.• We aim to classify hand lesions based on MR features such as margin, enhancement and bony involvement.• Classifying these lesions can help narrow down differential diagnoses and aid management.
“…Limited excision is the mainstay of conservative treatment for patients with neurological symptoms, macrodactyly, or the need for diagnostic surgical exploration. Complete excision is not recommended because of the high risk of neurologic morbidity2. To our knowledge, this is the first histopathologically confirmed case of lipomatosis of the nerves in the back, presented in the English-language literature.…”
mentioning
confidence: 85%
“…Lipomatosis of nerve is a rare benign lipomatous tumor consisting of proliferating fibrofatty tissues in the nerve branches1, and it was first described in the English-language literature in 19532. The tumor most often arises from the median nerve (66%~80%), and typically presents as a gradually growing nontender mass.…”
“…4,5 Further, several soft tissue lesions can be reliably identified with MRI alone, including lipoma, well-differentiated liposarcoma (atypical lipoma), benign nerve sheath tumors, diffuse pigmented villonodular synovitis, fibromatosis (extra-abdominal desmoid tumor), congenital venous malformations ("intramuscular hemangioma"), and periarticular cysts (eg, Baker cysts). [6][7][8][9][10][11] Need for Referral Several of these lesions are indolent and sufficiently identifiable by clinical and imaging findings that routine referral to orthopedic oncology is not required. 12,13 Of course, physicians must make the appropriate decision for their patients, taking into account the clinical findings and their own training and diversity of their practice.…”
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