28 years old man with chronic pelvic pain and urgencyand urgency

Images

Doctor's Information

Name : Noshin
Family : Behbodi
Affiliation :shahid beheshti medical university,shohadaye tajrish hospital,radiology department
Academic Degree : Assistant profeesor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : fatemeh mousavian

Case Section

Abdominal Imaging

Patient's Information

Gender : Female
Age : 28

Clinical Summary

chronic pelvic pain and urgency

Imaging Findings

an enhanced large multilobulated and conglomerated masses extending along nerves .these masses extends from spinal canal to gleuteal region through the neural foramina and sciatic notch T1 lowsignal and T2 is highsignal (target sign)

Differential Diagnosis

schwannomas and malignant peripheral nerve sheath tumours

Final Diagnosis

Neurofibroma

Discussion (Related Text)

Neurofibromas are benign peripheral nerve sheath tumours.
Three types have been described:
•localised neurofibroma
◦the most common form of neurofibroma, representing 90% of these lesions 2
◦the majority are solitary lesions and not associated with neurofibromatosis type 1 (NF1) 2
◦primarily affect superficial cutaneous nerves, however occasionally affect larger deep-seated nerves
◦slow growing
◦usually < 5 cm in size at presentation 3
•diffuse neurofibroma
◦mainly affect children and young adults
◦most frequently located within the subcutaneous tissues of the head and neck
◦90% are solitary lesions and not associated with nf1 2
◦cause plaque-like elevation of the skin with thickening of the entire subcutis 3
•plexiform neurofibroma
◦diffuse involvement of a long nerve segment and its branches, often extending beyond the epineurium into the surrounding tissue
◦pathognomonic of neurofibromatosis type 1 (nf1)
◦usually occur in early childhood
◦significant potential for malignant transformation 4
radiographic features
general imaging features of neurofibromas
ct
•well-defined hypodense mass
•minimal or no contrast enhancement
mri
•t1 hypointense
•t2 hyperintense
◦a hyperintense rim and central area of low signal resulting in a target sign may be seen; this is thought to be due to a dense central area of collagenous stroma
◦although this sign is highly suggestive of neurofibroma, it is occasionally also seen in schwannomas and malignant peripheral nerve sheath tumours
•t1 c+ (gd) heterogenous enhancement

References

http://radiopaedia.org/articles/neurofibroma