Small soft tissue masses indeterminate at imaging: histological diagnoses at a tertiary orthopedic oncology clinic

Kevin Pham, Nisreen S. Ezuddin, Juan Abelardo Augusto Pretell, Ty Subhawong

Research output: Contribution to journalReview article

1 Scopus citations

Abstract

Objective: To review histologic diagnoses of soft-tissue masses (STMs) ≤ 2 cm with indeterminate imaging features encountered in musculoskeletal oncology clinic at a tertiary referral center. Materials and methods: This was an IRB-approved retrospective review of patients with STMs ≤ 2 cm, referred to our tertiary care orthopedic oncology clinic over 4.75 consecutive years. Maximum diameter was based on imaging measurement by a fellowship-trained musculoskeletal radiologist. Simple lipomas, synovial cysts, metastases, and cases without histologic confirmation were excluded. Patient demographics, tumor imaging features (location, depth, size, and tumor:muscle enhancement and T2 signal ratios), and histology were recorded and compared. Results: Mean maximum diameter for 42 trunk/extremity STMs was 1.5 cm (range, 0.7 to 2 cm). Mean age was 48 years (range, 18–83 years). Nine (21%) of the masses were malignant, while 33 (79%) were non-malignant. Thirty-nine (93%) of masses were superficial; 7/39 (18%) of these superficial tumors were malignant. Malignancy was not associated with underlying vessels, tendon, or fascia (p = 0.19). The non-malignant vs. malignant tumor:muscle enhancement ratio was 2.15 vs. 2.32 (p = 0.58) and enhancement coefficient of variation was 0.14 vs. 0.10 (p = 0.29). Most common malignant histologic subtypes were synovial sarcoma (n = 3), fibroblastic/myofibroblastic sarcoma (n = 2), leiomyosarcoma (n = 2), myxofibrosarcoma (n = 1), and angiomatoid fibrous histiocytoma (n = 1). The majority (67%) of non-malignant lesions were: leiomyoma (n = 6), angiomyoma (n = 5), schwannoma (n = 4), benign fibrous histiocytoma (n = 4), and hemangioma (n = 3). Conclusions: At a tertiary musculoskeletal oncology referral clinic, primary STMs ≤ 2 cm with indeterminate imaging features should be managed cautiously despite their small size and/or superficial location.

Original languageEnglish (US)
JournalSkeletal Radiology
DOIs
StatePublished - Jan 1 2019

Keywords

  • Indeterminate
  • MRI
  • Sarcoma
  • Soft tissue mass
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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