Soft tissue sarcoma recurrence

Case contributed by Marina Goymer

Presentation

Soft tissue sarcoma post excision, radiotherapy and chemotherapy complicated by cellulitis. Now presents with 10cm X 3cm subcutaneous mass in the posterior thigh suggestive of recurrence.

Patient Data

Age: 51
Gender: Male
Modality: MRI

The palpable lump corresponds to an enhancing mass with both cystic and solid components in the subcutaneous fat of the medial thigh.  This mass measures 4.2cm X 3.2cm in transverse diameter, and 5.3cm in craniocaudal diameter.

The mass appears primarily solid and demonstrates nodular enhancement following gadolinium administration but also contains two ill-defined but focal hypo-enhancing areas within it's superior aspect measuring 1.3cm and more inferiorly measuring 1.9cm; these may represent areas of central necrosis.

There are two small areas of high signal within the solid portions of the mass on the pre-contrast T1-weighted images which may represent areas of haemorrhage.  There is high signal oedema diffusely infiltrating the subcutaneous fat adjacent to the mass over the medial aspect of the thigh, but also over the posterio-lateral aspect to a lesser extent.  Some high signal oedema is also noted in some of the adjacent muscles, most prominently in the inferior aspect of the adductor magnus and biceps femoris muscles and there is also the suggestion of some fatty replacement in these muscles which may represent some post-radiotherapy change.

These findings are suspicious for recurrence neoplasm in the current context, and fine needle aspiration may be helpful in confirming this is clinically indicated.

Acquired on a 1.5T Toshiba Titan.

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Case Information

rID: 25824
Case created: 11th Nov 2013
Last edited: 26th Sep 2015
Inclusion in quiz mode: Included

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