Grading of subcutaneous soft tissue tumors by means of their relationship with the superficial fascia on MR imaging

Abstract

Malignant tumors of the subcutaneous compartment have a higher tendency to develop a close relationship with the fascia than benign lesions. Obtuse angles between superficial fascia and a subcutaneous mass or a lesion crossing the fascia strongly suggest malignancy.

Subcutaneous angioleiomyomas: Gray‐scale and color Doppler sonographic appearances

“…8,11 Clinically, the major differential diagnoses included localized villonodular synovitis, lipomas, hemangiomas, nerve sheath tumors, and ganglia. [8][9][10][11][13][14][15][16] An accurate sonography can help in differential diagnosis with lipomas and ganglia. [9][10][11][12][13][14][15] However, differentiating between angioleiomyomas and circumscribed haemangiomas, glomic tumors, and neural tumors is not possible on the basis of sonographic features alone.…”

Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients

“…They were based on parameters such as origin, size, shape, margins, SI on different pulse sequences, signal homogeneity, changing pattern of homogeneity (T1-T2), grade and pattern of contrast enhancement, low SI septations, hemorrhage, peri-tumoral edema, distribution (intra-compartimental or extra-compartimental, neurovascular bundle displacement or encasement and bone involvement), fluid-fluid levels, signal voids, fat induction and intra-tumoral necrosis [9,11,17,22].…”

Test yourself: answer – deep benign fibrous histiocytoma

“…However, there is notable overlap in the presentation of benign and malignant diseases. For example, superficial sarcomas certainly occur, often involving the investing fascia; myxomas may demonstrate peritumoral edema; large deep BFH may have a pseudocapsule and internal necrosis; and cutaneous LMS and DFSP may be small, superficial, and well defined [5,[7][8][9]. With that said, caution in preoperative diagnosis remains paramount [10].…”

“…With that said, caution in preoperative diagnosis remains paramount [10]. In this case, despite the large size and internal heterogeneity, several imaging features suggested benignity including age, location, smooth margins, absence of fascial involvement, and lack of peritumoral edema [5,[7][8][9][10]. When considering these findings in light of common benign neoplasms of the lower extremity, a confident preoperative diagnosis may be presented which, in turn, may influence surgical approach.…”