Undifferentiated pleomorphic sarcoma

Case contributed by Ammar Ashraf
Diagnosis certain

Presentation

Left thigh pain and swelling associated with paraesthesia and heaviness for 3 months.

Patient Data

Age: 40 years
Gender: Female
This study is a stack
Axial
T2
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Sagittal
T2
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Sagittal
T2 TIRM
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Sagittal
T1
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Coronal
T2
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Axial T1
fat sat
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Axial
DWI
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Axial
ADC
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Axial T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Sagittal
T1 C+
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Info

Large well-defined heterogeneous soft tissue mass lesion occupying most of the left vastus intermedius muscle. It measures about 17 x 11 x 10 cm and is isointense to muscles on T1 and mildly hyperintense on T2-weighted images. Mild diffusion restriction is noted on diffusion weighted images. Post-contrast images show extensive enhancement of the solid component and multiple non-enhancing necrotic areas. Extensive high T2 signal (oedema or infiltration?) is noted in the remaining portion of the muscle. Intact vastus lateralis, vastus medialis as well as rectus femoris muscle. No signs of invasion of the underlying femur. The neurovascular bundle (in the abductor canal) is intact.

PET-CT

Nuclear medicine
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Info

A heterogeneously hypermetabolic aggressive-looking mass involving the musculature of the lateral compartment of the left thigh. The lesion has a  standardised uptake value of 23 and is in very close proximity to the femoral cortex.

Biopsy
report
Biopsy
report
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Info

Histopathology showed undifferentiated pleomorphic sarcoma.

Case Discussion

Sizeable malignant-looking hypermetabolic mass involving the left vastus intermedius muscle. Imaging features are suggestive of soft tissue sarcoma like undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma (MFH), rhabdomyosarcoma or malignant peripheral nerve sheath tumour.

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