Ultrasonography of Pediatric Superficial Soft Tissue Tumors and Tumor-Like Lesions

Abstract

Ultrasonography (US) is usually the first imaging examination performed to evaluate palpable or visible superficial soft tissue lesions that are common in children. Although clinical assessments, such as age at presentation, clinical course, and overlying skin discoloration, are important for the differentiation of pediatric soft tissue lesions, US allows a specific diagnosis of some typical benign lesions and helps in guiding further investigation since it provides detailed information about the lesion location, characterization including solid versus cystic, vascularity, and compressibility. Therefore, sufficient knowledge of the normal anatomy, proper ultrasonographic techniques, and the imaging findings of common and uncommon soft tissue lesions in children are crucial for accurate assessment and management of patients. In this article, we review the techniques and imaging findings focusing on the ultrasonographic features of a variety of superficial soft tissue lesions detected in children.

Role of Ultrasound In The Diagnosis of Primary And Recurrent Dermatofibrosarcoma Protuberans

“…DFSP is frequently small and super cial because of it progresses slowly over a long period of time before entering a rapid growth phase. The US is quick, inexpensive and accessible [19]. Therefore, it is commonly utilized for the initial assessment of super cial soft-tissue masses, including DFSP, and can be used as a routine examination for DFSP.…”

“…DFSP is nonspeci c and can easily be confused with other super cial masses such as epidermal cysts, pilomatricoma, lipoma, and dermato broma [19,27]. The differential diagnosis of DFSP from other super cial soft-tissue tumors is very important because the treatment strategies and prognoses differ.…”

“…DFSP is hypoechoic or mixed echogenic and not oating. Furthermore, on CDFI, epidermal cysts usually have no blood ow, while DFSP tumors often have plenty of color signals within and around the lesion, as described in Table 2 [6,19]. Pilomatricoma, originating from hair cortex cells, shows a well-de ned mass with inner echogenic foci and a peripheral hypoechoic rim or a completely echogenic mass with strong posterior acoustic shadowing because of calci cation in the subcutaneous layer.…”

“…However, no calci cation was observed in any of the DFSP patients, and most lesions had posterior reinforcement [18]. Lipoma often occurs in the subcutaneous adipose tissue of the limbs and is derived from mature adipose tissue [6,19]. Lipoma typically appears as a well-de ned oval or pad-like mass with ne linear striations and little or no increased blood ow.…”

“…Dermato broma, whether single or multiple, occurs in various parts of the limbs, accompanied by thickening of the skin tissue. On the US, dermato bromas are usually visible as avascular dermal lesions and are characterized by ill-de ned margins, marginal spiculation, and changes in the echogenicity of the surrounding soft tissues [19,28].…”