A middle age man presenting with ankle swelling

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : ----------------
Academic Degree: ----------------
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mani Armand

 

Patient's Information

Gender : Male
Age : 38

 

Case Section

Muskuloskeletal System

 

Clinical Summary

A middle age man presenting with ankle swelling and pain

 

 

Imaging Procedures and Findings

Heterogeneous lobulated soft tissue mass in anterolateral aspect of the ankle with invasion to the talus and calcaneous bones is noted. There is no invasion to the tibiotalar, subtalar and distal tibiofibular joints. The lesion has low signal intensity in short TR and high signal intensity in long TR sequences and shows intense enhancement in post-Gd sequences.

 

Discussion

Leiomyosarcomas are malignant mesodermal tumors associated with smooth muscle differentiation. The majority of patients presenting with soft tissue leiomyosarcoma are middle-aged to older adults, with a median age in the fifth and sixth decade, although rarely, leiomyosarcoma may present in children. The most common soft tissue location is the retroperitoneum, with approximately 20% to 67% of lesions occurring in this loction. approximately 12% to 41% of leiomyosarcomas occur in the peripheral soft tissue, with the thigh the most common peripheral location. In the extremities, leiomyosarcoma typically presents as a painless, slowly growing soft tissue mass, which may appear benign clinically. Leiomyosarcoma arising in soft tissue can be divided into several subgroups; cutaneous, major vessel, and soft tissue. Leiomyosarcomas arising in association with major arteries and vein are rare. Somatic soft tissue leiomyosarcomas arise in the superficial or deep soft tissue of extremities, where they are usually intimately associated with a small vessel. Lieomyosarcomas appear as soft tissue lesions rarely containing mineralization evident on plain films and/or CT. Zones of low attenuation from necrosis or cystic changes can also be seen with CT. Uncommon, CT readily shows zones of medullary and cortical destruction, and extra-osseous extension of tumors as well as mineralization. Pathologic fracture may be evident. Lesions may have well-defined or irregular margins, solid portions of the lesions usually have low-intermediate signal on T1WI and PDWI; and intermediate to slightly high or high signal on T2WI and FST2WI. Large lesions often have zones of necrosis or cystic changes which have low signal on T1WI and high signal on T2WI. After Gd-contrast administration, solid portions of the lesions usually show moderate to marked enhancement. MRI can show zones of bone erosion or invasion.

 

Final Diagnosis

Soft tissue leiomyosarcoma

 

References

Imaging of soft tissue tumors. By Mark J. Kransdorf, Mark D. Murphey. Page 307 MRI of bone and soft tissue tumors and tumorlike lesions: differential diagnosis and atlas. By Steven P. Meyers. Page 525

 

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