Imaging Features of Superficial and Deep Fibromatoses in the Adult Population

Abstract

<jats:p>The fibromatoses are a group of benign fibroblastic proliferations that vary from benign to intermediate in biological behavior. This article will discuss imaging characteristics and patient demographics of the adult type superficial (fascial) and deep (musculoaponeurotic) fibromatoses. The imaging appearance of these lesions can be characteristic (particularly when using magnetic resonance imaging). Palmar fibromatosis demonstrates multiple nodular or band-like soft tissue masses arising from the proximal palmar aponeurosis and extending along the subcutaneous tissues of the finger in parallel to the flexor tendons. T1 and T2-weighted signal intensity can vary from low (higher collagen) to intermediate (higher cellularity), similar to the other fibromatoses. Plantar fibromatosis manifests as superficial lesions along the deep plantar aponeurosis, which typically blend with the adjacent plantar musculature. Linear tails of extension (“fascial tail sign”) along the aponeurosis are frequent. Extraabdominal and abdominal wall fibromatosis often appear as a heterogeneous lesion with low signal intensity bands on all pulse sequences and linear fascial extensions (“fascial tail” sign) with MR imaging. Mesenteric fibromatosis usually demonstrates a soft tissue density on CT with radiating strands projecting into the adjacent mesenteric fat. When imaging is combined with patient demographics, a diagnosis can frequently be obtained.</jats:p>

The Imaging Features of Desmoid Tumors: the Usefulness of Diffusion Weighted Imaging to Differentiate between Desmoid and Malignant Soft Tissue Tumors

“…In a previous study (9), the maximum standardized uptake values (SUV max ) of the desmoid tumors ranged from 3.4 to 5.4, which is similar to the values found in our study (mean 3.7, 2.4-4.5). Our study demonstrated that the mean SUV max of the desmoid tumors was significantly lower than that of the malignant tumors.…”

“…Fibromatosis can be classified according to its anatomical location into superficial and deep fibromatosis, which show different genetic backgrounds and clinical behavior (9,16,17). Superficial fibromatosis arises from fascia or aponeuroses in the extremities including palmar, plantar, penile and knuckle pad locations and usually exhibits less symptomatic and slow-growing features compared to deep fibromatosis.…”

“…Desmoid tumors are benign fibromatous tumors characterized by histopathologically abnormal fibroblastic/myofibroblastic proliferation and marked accumulation of intracellular collagen (5-7). They can arise from any part of the body and are classified into the intraabdominal, abdominal wall, and extra-abdominal subtypes according to location (8,9). Although histologically benign, desmoid tumors are often locally invasive and associated with a high local recurrence rate after resection (3,10).…”

“…Previously reported findings of the imaging of desmoid tumors demonstrated varying degrees of homogeneous enhancement on CT and MRI scans and may show a massforming or infiltrative growth pattern (2,9,11). However, the imaging findings of desmoid tumors reported thus far are very diverse and often similar to those of malignant tumors in signal intensity (SI), tumor margination, and in the tendency to encase adjacent organs (12)(13)(14).…”

Acral manifestations of soft tissue tumors

“…Selective fasciotomy is the treatment of choice. 23,24 Excision of these lesions reveals a collection of small nodules within the subcutis and aponeurosis, with a yellow-tan appearance for younger lesions and a gray-white appearance for older ones. This agedependent difference in appearance reflects the tumor composition on light microscopy, further illustrated in Figure 7.…”