K.E.M.
Radiology
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Department of Radiology
Seth G.S. Medical College and K.E.M. Hospital, Mumbai , India
Case of the Month
Clinical Profile:
A 72-year-old woman came with the complaints of gradually increasing breathlessness for one year, associated with weight loss for the last two months.
• She gave history of swelling in the right thigh region for the last 20 years which became more evident in the last two months due to weight loss.
Fig. 1 :On examination, there was a large painless swelling over posterior aspect of upper part of the right thigh. The swelling is hard and circumscribed. The overlying skin is normal.
Radiological findings:
Plain radiograph:
Frontal chest radiograph shows multiple well defined fluffy cotton wool spots scattered throughout both the lung fields.
Right femur radiograph shows a well-defined soft tissue opacity in the upper aspect of the right thigh. There is no calcification within. There is no involvement of the underlying bone.
Fig. 2 : Frontal chest radiograph shows multiple well-defined fluffy cotton wool spots scattered throughout both the lung fields.
Fig. 3 : Right femur radiograph shows a well-defined soft tissue opacity in the upper aspect of the right thigh. There is no calcification within. There is no involvement of the underlying bone.
CECT Chest:
• shows multiple variable sized well defined, round, enhancing soft tissue density lesions scattered in both the lung parenchyma, largest measuring 4.9x4.5x4.6cm in the anterior segment of the right upper lobe.
CECT Right thigh:
• shows a well-defined heterogeneously enhancing multiloculated mass in the posterior aspect of the right upper thigh in gluteus maximus muscle causing splaying of its lower insertion fibres.
• The lesion measures 7.8x11x13.6 cm with multiple vascular channels supplying it.
• Anteriorly the lesion is seen displacing adjacent hamstrings and adductor muscles with maintained fat planes.
• Posteriorly the lesion is not extending into skin.
• Adjacent shaft of right femur appears unremarkable.
Fig. 4 : The plain[A] and contrast enhanced[B] computed tomography of the chest shows multiple variable sized well defined, round, enhancing soft tissue density lesions scattered in both the lung parenchyma, largest measuring 4.9x4.5x4.6cm in the anterior segment of the right upper lobe.
Fig. 5 :Plain computed tomography image of the right thigh in axial[A]. Sagittal[B], coronal[C] section shows a well-defined multiloculated mass in the posterior aspect of the right upper thigh in gluteus maximus muscle.
Fig. 6 Contrast enhanced computed tomography image of the right thigh in axial[A]. Sagittal[B], coronal[C] section shows the mass is heterogeneously enhancing and measures 7.8x11x13.6 cm with multiple vascular channels supplying it
MRI right thigh:
• There is a well-defined multilobulated T2 heterogeneous lesion measuring 8.7x10x15cm with multiple hypointense fibrous thin septae, with thick peripheral homogeneous enhancement.
• There are areas of T1 hyperintensities within few of the locules suggestive of haemorrhage.
• It is seen arising from the gluteus maximus extending in the intramuscular plane of the right posterior thigh and extending superficially into the subcutaneous plane posteriorly.
• The adductor magnus is displaced anteriorly.
Fig. 7 MRI of the right thigh in axial section of T2 weighted[A] image shows a well-defined multilobulated T2 heterogeneous lesion measuring 8.7x10x15cm with multiple hypointense fibrous thin septae. The lesion shows thick peripheral homogeneous enhancement in post contrast image[B]T1 weighted coronal[C] section shows areas of hyperintensities within few of the locules suggestive of haemorrhage.
Radiological diagnosis:
Undifferentiated sarcoma
Pathological diagnosis and treatment:
An ultrasound guided biopsy of the right thigh swelling was performed and histopathology showed low grade fibro-myxoid sarcoma
Fig. 8 Histopathological image shows the myxoid areas are moderately cellular and the bland lesion cells are fusiform or spindle.