vol 15 ppt
DESCRIPTION
TRANSCRIPT
![Page 1: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/1.jpg)
Volume 15 Lipid Soft Tissue Tumors
Superficial lipomas-------------Case 1183
Intramuscular lipomas----------Case 270-274 & 1184-1190
Spindle cell lipomas------------Case 275-276
Angiolipomas--------------------Case 277-278 & 1191-1196
Ossifying lipoma----------------Case 1196.1-1196.3
Myxolipomas--------------------Case 279
Diffuse lipomatosis-------------Case 280
Lumbosacral lipoma------------Case 281
Hibernoma-----------------------Case 1197
Liposarcoma
Well differentiated------------Case 283 & 1198
Myxoid-------------------------Case 285-289 & 1199-1201
Round cell---------------------Case 290
Pleomorphic-------------------Case 291 & 1202-1203
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Vascular Soft Tissue Tumors
Hemangioma---------------------Case 292-298 & 1204-1211
Hemangiomatosis---------------Case 299-300 & 1212
Lymphangioma------------------Case 301-304 & 1213
Glomus tumor-------------------Case 305-307
Hemangiopericytoma-----------Case 308-311
Kaposi’s sarcoma----------------Case 312-313
Angiosarcoma--------------------Case 314
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Lipid Tumors
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Superficial Lipoma
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Superficial Lipomas
Lipomas are by far the most common soft tissue tumor encountered
in orthopedic oncology. There is a large number of variants, the most
common being the superficial subcutaneous lipoma that occurs in
both males and females in an older age group, the 5th and 6th decade
of life. Typical lesions are seen in the back, shoulder and neck. On
palpation, these tumors have a soft non-tender characteristic. They
occur more commonly in obese patients, however, when patients
lose weight dramatically, the size of the lipoma will not vary. In
older patients they grow quite rapidly at first but then stop. They
never convert into a malignant tumor at some later date. Surgical
treatment usually consists of a cosmetic resection and the recurrence
rate is less than 5%.
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Case #1183
51 year male with superficial lipoma arm
Coronal T-1 MRI
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Another coronal T-1 MRI
tumor
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Axial T-1 MRI
tumor
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Surgical specimen
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Photomic
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Case #1183.1
71 year female with recent shoulder dislocation and history of a soft
tissue lump over back of shoulder for years
Superficial lipoma
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Axial T-1 Gad
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Case #1183.2 Superficial lipoma
Axial T-1 PD FS
42 yr male with one yr history of painless lump on shoulder
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Intramuscular
Lipomas
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Intramuscular Lipoma
The intramuscular lipoma occurs in adults between the ages of
30 and 60 years, and is usually found in the larger muscle groups.
The tumor occurs quite gradually, without symptoms of pain, and
does not cause disability when left untreated. It is usually
recognizable on routine radiographic exam, showing a well-
marginated lesion with a radiodensity less than that of the
surrounding muscle. However, the best imaging study for a lipoma
of muscle is the MRI which shows a diagnostic high signal,
lobulated lesion on the T-1 weighted image that has the exact
same appearance as the subcutaneous fat. On the T-2 image, the
lesion will be an intermediate signal and again have the exact
appearance of subcutaneous fat. Histologically, the intramuscular
lipoma demonstrates large lipocytes with very small pyknotic
nuclei. The pathologist must be very careful to look for evidence of
atypical lipoblasts that would suggest the diagnosis of a well-
differentiated liposarcoma that can coexist with a benign lipoma.
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On rare occasion, lipomas can have coexistent chondroid or osseous
hamartomatous elements that in the past had been classified as
mesenchymomas. Surgical treatment for the intramuscular lipoma is
a marginal resection, being careful to avoid damage to the neuro-
vascular structures that might pass through the lipoma. The
recurrence rate is higher than for subcutaneous lipomas and range
between 15 and 60%.
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CLASSIC
Case #270
72 year male with an
intramuscular lipoma
quadriceps muscle
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Coronal T-1 MRI
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Another coronal T-1 MRI
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Axial T-1 MRI
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Gross specimen
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Photomic
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Case #270.1
Axial T-1 T-1 STIR
72 year female with painless mass in anterior thigh for years
Intramuscular lipoma
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Coronal T-1 Sagittal T-1 Coronal STIR
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Case #270.2 Axial T-1 T-2
Gad
56 year male with painless soft
mass in anterior thigh for 2 years
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Sag T-1 T-2 FS
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Case #270.3
65 year old female with
3 yr history of large painless
mass in posterior thigh
Intraneural lipoma sciatic nerve
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Sag T-1 T-2
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Axial T-1 PD
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Surgical resection
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Case #271
74 year female with intramuscular lipoma hand
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Coronal T-1 MRI
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Axial T-1 MRI
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Surgical resection
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Photomic
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Case #272
47 year female with intramuscular lipoma foot
Sagittal T-1 MRI
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Axial T-1 MRI
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Coronal T-1 MRI
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Case #273
11 year male
lipoma
deltoid muscle
Axial T-1 MRI
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Coronal T-1 MRI
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Case #273.1
43 year female with soft painless mass in axilla
Axial T-1
T-2
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Sag T-1 T-2
Cor T-1
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Case #274
67 year male
calcifying necrotic
lipoma
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Resected specimen cut in path lab
calcification
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Case #1184
58 year female with
intramuscular lipoma
buttock area
![Page 46: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/46.jpg)
Axial T-1 MRI showing lipoma extruding thru the sciatic notch
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Coronal T-1 MRI showing lipoma extrusion thru the notch
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Surgical specimen
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Case #1184.1
51 year old male with soft painless mass in buttocks for 5 yrs
CT scan Lipoma
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Axial T-1 T-2
Gad
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Cor T-1 T-2
Gad
![Page 52: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/52.jpg)
Sag gad
![Page 53: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/53.jpg)
Case #1185
59 year female with
intramuscular lipoma
anterior proximal thigh
Coronal T-1 MRI
![Page 54: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/54.jpg)
Axial T-2 MRI
![Page 55: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/55.jpg)
Axial T-2 MRI
at lower level
![Page 56: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/56.jpg)
Fat subtraction MRI
showing signal void
in lipoma
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Case #1186
51 year male with
intramuscular lipoma
posterior compartment
thigh
![Page 58: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/58.jpg)
Axial T-1 MRI
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Case #1187
62 year female with
intramuscular lipoma
adductor compartment
thigh
Coronal T-1 MRI
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Surgical exposure of tumor
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Case #1188
72 year female with
intramuscular lipoma
mid arm
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Axial T-1 MRI
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Case #1189
2 year male with
intramuscular lipoma
posterior thigh
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AP view
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Case #1190
66 year female with intramuscular lipoma forearm
![Page 66: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/66.jpg)
CT scan
tumor
![Page 67: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/67.jpg)
Case #1190.1
55 year female with painless mass in forearm over 1 yr
Intramuscular lipoma
![Page 68: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/68.jpg)
Sagittal MRI
T-1 T-1 PD-FS Gad
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Axial T-1
Gad
![Page 70: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/70.jpg)
Surgical resection
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Case #1190.2
33 year old female with
painless lump at ankle
for 1 year
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Sag T-1 PD Gad
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Axial T-1 Gad
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Surgical excision
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Spindle Cell
Lipomas
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Spindle Cell Lipoma
The spindle cell lipoma is seen more commonly in men between
the ages of 45 and 65 years and is typically located in the posterior
neck or shoulder area. MRI imaging demonstrates the high signal
features of a lipoma on the T-1 weighted image but with areas of
lower signal streaking seen throughout the high signal areas where
the fibrous tissue is located. Histologically, the spindle cell lipoma
looks like any other lipoma except for the presence of benign-
appearing fibrous tissue with occasional areas of gelatinous break-
down in the fibrous tissue. The treatment for this variant is a
marginal resection and carries a minimal chance for local recurrence.
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CLASSIC Case #275
59 year male with spindle cell lipoma thigh
CT scan
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Case #276
64 year male with spindle cell lipoma proximal forearm
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Sagittal T-1 MRI
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Axial T-1 MRI
![Page 81: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/81.jpg)
Axial proton density MRI
![Page 82: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/82.jpg)
Angiolipomas
![Page 83: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/83.jpg)
Angiolipoma
The angiolipoma is another variant of the lipoma occurring usually
in subcutaneous locations in young adult patients. It is seen most
commonly in the forearm. These lesions may be multiple and can be
painful because of their increased vascularity. These lesion can be
seen on routine radiographs when phleboliths are present in the
vascular component, but the most diagnostic imaging study is the
MRI that will show the high signal features of a lipoma on the T-1
weighted image with the additional serpinginous low signal pattern
of vascular tissue streaking throughout the high signal lipomatous
tissue. Treatment for this variant is a simple marginal resection
from which one can expect a relatively low recurrence rate.
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CLASSIC Case #277
27 year female with angiolipoma forearm showing
phleboliths and hypertrophic subadjacent radius
phleboliths
![Page 85: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/85.jpg)
Sagittal T-1 MRI showing low signal serpinginous
vessels running thru high signal lipoma tissue
![Page 86: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/86.jpg)
Resection specimen showing serpinginous vessels in fat
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Case #278 Coronal T-1 MRI
16 year female with angiolipoma quadriceps muscle
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Axial T-1 MRI
![Page 89: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/89.jpg)
Case #1191
24 year female with
angiolipoma anterior
thigh
Sagittal T-1 MRI
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Axial T-1 MRI
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Coronal T-2 MRI
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Sagittal gad
contrast MRI
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Case #1192
23 year female with
angiolipoma anterior
to hip joint
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Axial T-1 MRI
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Sagittal T-1 MRI
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Coronal T-1 MRI
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Case #1194
41 year male with
angiolipoma thigh
Coronal T-1 MRI
![Page 98: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/98.jpg)
Axial T-1 MRI
![Page 99: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/99.jpg)
Case #1194.1
33 year female with painless mass in anterior thigh 1 year
Axial T-1 MRI
![Page 100: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/100.jpg)
Axial T-2
Axial Gad Contrast
![Page 101: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/101.jpg)
Sagittal T-2 Sagittal Gad
![Page 102: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/102.jpg)
Case #1195
17 year female with
angiolipoma forearm
Sagittal T-1 MRI
![Page 103: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/103.jpg)
Coronal T-1 MRI
![Page 104: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/104.jpg)
Axial T-2 MRI
![Page 105: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/105.jpg)
Case #1196
33 year male with
angiolipoma calf
![Page 106: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/106.jpg)
Axial T-1 MRI
![Page 107: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/107.jpg)
Sagittal T-1 MRI
![Page 108: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/108.jpg)
Ossifying Lipoma
The ossifying lipoma is a very rare variant of the lipoma
with only 12 cases in the literature most of which were
located in the head and neck area. Four extremity cases
were located in the shoulder, thigh and hand in middle aged
patients. Bone and cartilage may be found in the central area
of the lipoma and is thought to be a dysplastic or hamart-
omatous process similar to the mesenchymoma. They are not
attached to bone as in the case of the parosteal lipoma. They
are painless lesions that grow slowly over years and are easy
to resect with little chance of recurrence.
![Page 109: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/109.jpg)
Case #1196.1
75 yr female with painless soft mass in thigh for 10 yrs
Ossifying Lipoma
![Page 110: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/110.jpg)
Axial T-1
![Page 111: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/111.jpg)
Sag T-1 Axial T-2
![Page 112: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/112.jpg)
bone
Necrotic tumor
fat
Surgical removal of the
large mass from the
quadriceps muscle
![Page 113: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/113.jpg)
Photomics show typical
lipoma tissue covering
necrotic ossifying tissue
![Page 114: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/114.jpg)
Post op appearance following resection
![Page 115: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/115.jpg)
Case #1196.2 Ossifying Lipoma
53 yr male with painless
mass in knee for 3 yrs
Cor T-1 Axial T-2
![Page 116: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/116.jpg)
Case #1196.3
60 yr female with painless forearm mass for 2 years
Ossifying lipoma
![Page 117: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/117.jpg)
Sag T-1 T-2 FS Gad
![Page 118: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/118.jpg)
Axial T-1 T-2 FS
Gad
![Page 119: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/119.jpg)
Myxolipoma
![Page 120: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/120.jpg)
CLASSIC Case #279 Sagittal T-1 MRI
63 year female with myxolipoma knee
![Page 121: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/121.jpg)
Sagittal T-2 MRI
![Page 122: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/122.jpg)
Axial T-1 MRI
![Page 123: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/123.jpg)
Diffuse
Lipomatosis
![Page 124: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/124.jpg)
Diffuse Lipomatosis
An extremely rare variant of the lipoma is the diffuse lipomatosis
form seen during the first two years of life. It may involve one
entire extremity or the trunk, demonstrating both superficial and
deep intramuscular, multifocal lesions. Histologically, these lesions
are identical to that of a benign lipoma and because of the massive
involvement of the extremity in some cases, amputation may be
indicated.
![Page 125: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/125.jpg)
CLASSIC Case #280
20 year male with diffuse lipomatosis lower extremities
![Page 126: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/126.jpg)
CT scan
![Page 127: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/127.jpg)
Another CT cut
![Page 128: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/128.jpg)
Lumbosacral
Lipoma
![Page 129: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/129.jpg)
Lumbosacral Lipoma
The lumbosacral lipoma variant is frequently associated with a
spinabifida defect in the spine and can be seen in both the pediatric
and adult age group. These lesions can be associated with both intra-
dural and extradural lipomas and can result in neurological deficiency.
The MRI image will show the characteristic high signal response
on the T-1 weighed image, like all other forms of lipomas. Treatment
consists of a marginal surgical resection, including the lesions within
the vertebral canal. A low recurrence rate is anticipated.
![Page 130: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/130.jpg)
CLASSIC
Case #281
Sagittal T-1 MRI
lumbosacral lipoma
61 year male
![Page 131: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/131.jpg)
Axial T-1 MRI
![Page 132: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/132.jpg)
Synovial Lipoma
![Page 133: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/133.jpg)
Case #281.1
26 year male with injury to shoulder 6 years ago
Synovial lipoma
![Page 134: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/134.jpg)
Axial T-1
Axial T-2
![Page 135: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/135.jpg)
Cor T-1
Cor T-2
![Page 136: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/136.jpg)
Sag T-2
![Page 137: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/137.jpg)
Case #281.2 Synovial lipoma knee Axial
T-1 T-2
Gad
48 year old female with
tender lump over medial
retinaculum for l year
![Page 138: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/138.jpg)
Coronal T-1 T-2 Gad
![Page 139: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/139.jpg)
Sagittal T-1 T-2 Gad C+
![Page 140: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/140.jpg)
Hibernoma
![Page 141: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/141.jpg)
Hibernoma
The hibernoma is a very rare lipoma variant seen usually in young
adults in the intrascapular area of the back. It is painless and slow
growing and ranges between 10 and 15 cm in diameter. Histolo-
logically, the hibernoma demonstrates fine granular or vaculated
cells consisting of brown fat and large amounts of glycogen. The
treatment for this lesion is simple marginal resection with a very
low potential for local recurrence.
![Page 142: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/142.jpg)
Case #1197
CLASSIC
37 year female with
hibernoma triceps m
Sagittal T-1 MRI
![Page 143: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/143.jpg)
Axial T-1 MRI
![Page 144: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/144.jpg)
Axial T-2 MRI
![Page 145: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/145.jpg)
Axial gad
contrast MRI
![Page 146: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/146.jpg)
Sagittal gad contrast
MRI
![Page 147: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/147.jpg)
Surgical specimen showing tan color
![Page 148: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/148.jpg)
Photomic
![Page 149: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/149.jpg)
Photomic
![Page 150: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/150.jpg)
Case #1197.1
38 year female with painless hibernoma anterior thigh
Sag T-1 MRI Cor T-1 MRI Axial T-1 MRI
![Page 151: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/151.jpg)
Sagittal T-2 MRI Sagittal Gad MRI
![Page 152: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/152.jpg)
Case #1197.2
28 yr male with fullness in groin area for 1 yr
hibernoma
![Page 153: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/153.jpg)
Axial T-1 PD
Gad
![Page 154: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/154.jpg)
Sag PD Sag Gad
![Page 155: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/155.jpg)
Case #1197.3 Axial T-1 Axial T-2 MRI
2.5 yr male with painless buttock lump for 1 year
with tissue diagnosis of lipoblastoma
![Page 156: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/156.jpg)
Coronal T-1 MRI Coronal T-2 MRI
![Page 157: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/157.jpg)
Sagittal T-1 MRI Sagittal T-2 MRI
![Page 158: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/158.jpg)
Liposarcoma
![Page 159: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/159.jpg)
Liposarcoma
Second to the MFH, the liposarcoma is the most common soft
tissue tumor seen in the musculoskeletal system. These tumors are
seen typically in an older population group (over the age of forty)
and are slightly more common in males than females. They are
typically located in large muscle groups, especially in the lower
extremity where 70% of these tumors will be found. There are four
subtypes of liposarcoma, including the well-differentiated form
and the myxoid form that are low grade, and the round cell and
pleomorphic forms that are high grade.
![Page 160: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/160.jpg)
Well-differentiated
Liposarcoma
(Atypical Lipoma)
![Page 161: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/161.jpg)
Well-differentiated Liposarcoma
The well-differentiated liposarcoma is a very low grade variant
of the liposarcoma that looks almost like a benign lipoma. It occurs
in people past the age of 45 years and is commonly seen in the
lower extremity, especially in the buttock and thigh area, but can
also be found in the retroperitoneal portions of the body. On gross
examination, the well-differentiated form looks like a routine intra-
muscular lipoma, but microscopically the pathologist must find a
few areas of low grade lipoblasts with a signet ring appearance
to make this diagnosis. This lesion is sometimes referred to as an
atypical lipoma because its gross appearance is similar to the benign
lipoma. The prognosis for this variant is extremely good but with a
fairly high potential for local recurrence in about 30-50% of cases.
There is essentially no chance of this lesion metastasizing to distant
parts. If located in the retroperitoneal area, it can be fatal because
of the difficulty in removing the tumor.
![Page 162: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/162.jpg)
CLASSIC
Case #283
Coronal T-1 MRI
63 year female
Well-differentiated
liposarcoma thigh
![Page 163: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/163.jpg)
Resected surgical specimen
![Page 164: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/164.jpg)
Case #283.1 Well Differentiated Liposarcoma Thigh
68 yr old male with three time recurrence of soft mass in thigh
Cor T-1 STIR Gad
![Page 165: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/165.jpg)
Axial T-1 STIR
Gad
![Page 166: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/166.jpg)
Case #284
Coronal T-1 MRI
49 year male with
well-differentiated
liposarcoma (atypical lipoma)
distal thigh
![Page 167: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/167.jpg)
Sagittal T-1 MRI
![Page 168: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/168.jpg)
Axial T-2 MRI
![Page 169: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/169.jpg)
Case #1198
62 year male with well-differentiated liposarcoma thigh
Axial T-2 MRI
![Page 170: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/170.jpg)
Coronal T-2 MRI
![Page 171: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/171.jpg)
Case #1198.1
Sag T-1 PD
47 yr old female with mild intermittent pain in thigh 2 yrs
Atypical Lipoma
![Page 172: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/172.jpg)
Axial T-1 PD
Gad
![Page 173: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/173.jpg)
Case #1198.2
Coronal T-1 MRI of
the thigh of a 41 year
male with prior history
of partially resected
atypical lipoma 3 yrs
before
Dedifferentiated lipsosarcoma
![Page 174: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/174.jpg)
Axial PD Axial Gad
![Page 175: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/175.jpg)
Sagittal Gad
![Page 176: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/176.jpg)
Case #1198.3 CT scan 4/06
71 year old male with
painless soft mass in
adductor compartment
in 06 which became
painful with recent
growth in 09
![Page 177: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/177.jpg)
Sag T-1 Gad
09
![Page 178: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/178.jpg)
Axial T-1 upper T-2 upper
T-2 lower Cor STIR
![Page 179: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/179.jpg)
Surgical removal
![Page 180: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/180.jpg)
Case #1198.4 Sag T-1 T-2 FS Gad
45 yr female with atypical lipoma resected from calf 3 yrs ago
![Page 181: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/181.jpg)
Axial T-1 Gad
![Page 182: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/182.jpg)
Tumor resection off the posterior tibial nerve
nerve
![Page 183: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/183.jpg)
Myxoid
Liposarcoma
![Page 184: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/184.jpg)
Myxoid Liposarcoma
The myxoid variant is the most common variant of the lipo-
sarcoma and it is seen in a slightly younger age group between 40
and 50 years of age. It occurs in the lower extremities in 75% of
cases, especially in the popliteal area. These lesions are slow
growing and frequently asymptomatic in the early stages. On
imaging studies, the MRI is the best method for visualizing these
tumors that will have a mixed high and low signal on the T-1
weighted image because of the high percentage of fatty tissue in
the tumor. Histologically, there will be evidence of malignant
lipoblasts and it is common to find a plexiform network of small
capillary tubes running thru the fatty tumor, similar to the capillary
hemangioma. The prognosis for this variant is quite good after a
wide local surgical resection, followed in most cases by local
radiation therapy. The chance of pulmonary metastases runs as
high as 20% and occasionally there will be multifocal myxoid
![Page 185: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/185.jpg)
liposarcomas occurring in the extremities as well as in retro- peritoneal locations. Occasionally, one will see a transitional
form of myxoid converting into a higher grade round cell lipo-
sarcoma which carries a more guarded prognosis.
![Page 186: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/186.jpg)
CLASSIC Case #285 Sagittal T-1 MRI
67 year female with myxoid liposarcoma knee
![Page 187: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/187.jpg)
Sagittal T-2 MRI
![Page 188: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/188.jpg)
Axial T-2 MRI
![Page 189: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/189.jpg)
Resection specimen
![Page 190: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/190.jpg)
Photomic showing lipoblasts and vascular channels
![Page 191: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/191.jpg)
Case #286 Sagittal T-2 MRI
43 year male with myxoid liposarcoma behind knee
tumor
![Page 192: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/192.jpg)
Coronal T-2 MRI
tumor
![Page 193: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/193.jpg)
Axial T-1 MRI
tumor
![Page 194: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/194.jpg)
Surgical resection
![Page 195: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/195.jpg)
Cut specimen
![Page 196: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/196.jpg)
Photomic
vessel
lipoblasts
![Page 197: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/197.jpg)
Case #287
Coronal T-1 MRI
29 year male with
myxoid liposarcoma
posterior thigh
tumor
![Page 198: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/198.jpg)
Axial PD MRI
tumor
![Page 199: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/199.jpg)
Axial T-2 MRI
![Page 200: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/200.jpg)
Wide resection specimen
![Page 201: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/201.jpg)
Photomic showing numerous vascular channels
![Page 202: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/202.jpg)
Case #288 Coronal T-1 MRI
34 year female with myxoid liposarcoma thigh
![Page 203: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/203.jpg)
Coronal T-2 MRI
![Page 204: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/204.jpg)
Axial T-1 MRI
tumor
![Page 205: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/205.jpg)
Axial T-2 MRI
tumor
![Page 206: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/206.jpg)
Photomic
![Page 207: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/207.jpg)
Axial T-2 MRI showing multifocal involvement in abdomen
tumor
kidney
![Page 208: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/208.jpg)
Case #289
Sagittal T-1 MRI
32 year male with
myxoid liposarcoma
distal thigh
tumor
![Page 209: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/209.jpg)
Axial T-1 MRI
tumor
![Page 210: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/210.jpg)
Resected specimen
![Page 211: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/211.jpg)
Specimen cut in path lab
fat
myxoid
![Page 212: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/212.jpg)
Photomic
![Page 213: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/213.jpg)
Case #1199
30 year male with
myxoid liposarcoma
posterior thigh
Sagittal T-1 MRI
![Page 214: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/214.jpg)
Sagittal T-2 MRI
![Page 215: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/215.jpg)
Axial T-1 MRI
tumor
![Page 216: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/216.jpg)
Axial Gad contrast MRI
![Page 217: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/217.jpg)
Coronal Gad
contrast MRI
![Page 218: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/218.jpg)
Surgical specimen
![Page 219: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/219.jpg)
Photomic
![Page 220: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/220.jpg)
Case #1200 Sagittal T-1 MRI
75 year male with myxoid liposarcoma foot
![Page 221: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/221.jpg)
Another sagittal T-1 MRI
![Page 222: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/222.jpg)
Axial T-1 MRI
tumor
![Page 223: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/223.jpg)
Sagittal T-2 MRI
![Page 224: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/224.jpg)
Another sagittal T-2 MRI
![Page 225: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/225.jpg)
Sagittal Gad contrast MRI
![Page 226: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/226.jpg)
Photomic showing lipoblasts
![Page 227: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/227.jpg)
Case #1201
69 year male with myxoid liposarc pelvis
tumor
CT scan
![Page 228: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/228.jpg)
Axial T-2 MRI
![Page 229: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/229.jpg)
Photomic showing lipoblasts and vessels
![Page 230: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/230.jpg)
Case #1201.1
27 year male with
myxoid liposarcoma
vastus intermedius m.
Axial T-1 MRI
![Page 231: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/231.jpg)
Coronal T-1 MRI
![Page 232: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/232.jpg)
Coronal Gad
contrast MRI
showing femoral
artery
![Page 233: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/233.jpg)
Surgical incision including biopsy site
![Page 234: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/234.jpg)
Surgical exposure of tumor contained in muscle fascia
biopsy
![Page 235: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/235.jpg)
Tumor excised including periosteum
![Page 236: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/236.jpg)
Excised tumor mass contained in muscle fascia
biopsy site
![Page 237: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/237.jpg)
Wound closure
![Page 238: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/238.jpg)
Case #1201.2 Axial T-1 STIR
Gad 70 yr female with slightly
tender mass above elbow
for 1 year
Myxoid Liposarcoma Triceps
![Page 239: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/239.jpg)
Sag T-1 STIR Gad
![Page 240: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/240.jpg)
Ulnar N
Surgical resection
![Page 241: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/241.jpg)
Round Cell
Liposarcoma
![Page 242: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/242.jpg)
Round cell and Pleomorphic Liposarcoma
The round cell and pleomorphic liposarcomas are high grade
liposarcomas seen in the same locations as other liposarcomas in
a slightly older age group. They account for about 10% of all
liposarcomas. Because these are high grade they act more like a
high grade MFH with increased pain and rapid growth. On imaging
studies, the higher grade lesions take on the appearance of a more
aggressive sarcoma without the high signal appearance of fat on
the T-1 weighted image. Histologically, there will be evidence of
severe atypicism and bizarre-appearing giant cells with only
occasional areas of lipoblastic signet ring cells that are necessary
to make the ultimate diagnosis. These high grade lesions are treated
by wide surgical resection, followed by postoperative radiation
therapy and occasionally chemotherapy will be indicated for
aggressive lesions in a younger age group. The chance of
pulmonary metastases runs as high as 80% in these high grade
variants.
![Page 243: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/243.jpg)
CLASSIC
Case #290
38 year male with
high grade round cell
liposarcoma thigh
![Page 244: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/244.jpg)
Sagittal T-1 MRI
tumor
![Page 245: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/245.jpg)
Sagittal T-2 MRI
tumor
![Page 246: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/246.jpg)
Axial proton density MRI
tumor
![Page 247: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/247.jpg)
Photomic showing round cells and lipoblasts
![Page 248: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/248.jpg)
Pleomorphic
Liposarcoma
![Page 249: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/249.jpg)
CLASSIC Case #291 Sagittal T-2 MRI
44 year male with pleomorphic liposarcoma knee
tumor
![Page 250: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/250.jpg)
Sagittal T-1 MRI
tumor
![Page 251: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/251.jpg)
Axial gad contrast MRI
tumor
![Page 252: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/252.jpg)
Photomic showing bizarre pleomorphic giant cells
![Page 253: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/253.jpg)
Close up of pleomorphic lipoblasts
![Page 254: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/254.jpg)
Case #1202
80 year male with
pleomorphic liposarcoma
Sagittal T-1 MRI
![Page 255: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/255.jpg)
Sagittal T-2 MRI
![Page 256: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/256.jpg)
Surgical specimen
![Page 257: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/257.jpg)
Photomic
![Page 258: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/258.jpg)
Case #1203
61 year male with
pleomorphic liposarcoma
biceps muscle
Sagittal T-1 MRI
![Page 259: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/259.jpg)
Sagittal T-2 MRI
![Page 260: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/260.jpg)
Case #1203.1
65 year male with recent onset buttock tumor mass in area of previous
resected large benign lipoma 6 years ago
Axial CT scan Pleomorphic liposarcoma
![Page 261: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/261.jpg)
Sag CT scan Cor CT
![Page 262: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/262.jpg)
Axial T-1 T-2
Gad
fluid
tumor
![Page 263: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/263.jpg)
Sag T-2 Surgical specimen
![Page 264: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/264.jpg)
Vascular Tumors
![Page 265: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/265.jpg)
Hemangioma
![Page 266: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/266.jpg)
Hemangioma
After the benign lipoma, the benign vascular tumor is the second
most common soft tissue lesion seen in the human body. Hemangiomas
are developmentally dysplastic neoplasms of the endothelial tube.
They occur most commonly during childhood, more commonly in
females than males, and account for 70% of all benign tumors. The
most common type of hemangioma is the solitary capillary hem-
angioma that appears as an elevated red to purple cutaneous lesion,
usually in the head and neck area. It is usually seen during the first
few weeks after birth. The lesion will grow rapidly for a period of
several months and then disappear spontaneously over a period of
seven years in about 80% of cases. These lesions are essentially
cosmetic and do not deserve any aggressive form of treatment.
However, in the past, attempts at injecting them with sclerosing
agents or liquid nitrogen, or using radiation therapy, made the
situation more disabling than the original lesion. A less common
![Page 267: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/267.jpg)
form of hemangioma is the so-called cavernous hemangioma that
has a purplish-gray appearance and can look similar to varicosities
in the extremities but in a younger age group. They can involve
large muscle groups in the extremity and can even involve synovial
membranes in joints.
Radiographically, the hemangioma may present with small,
punctate, calcific deposits within the tumor that is almost diagnostic
of this condition. These are referred to as phleboliths. The use of
MRI technology is very helpful in making the diagnosis of a hem-
angioma and the characteristic sharp mixed signal serpinginous
pattern is seen clearly on the T-1 weighted images. As with the
cutaneous hemangioma, the larger intramuscular hemangiomas in
children are not very disabling but can create symptoms of pain
caused by spontaneous hemorrhage into the lesion with minimal
blunt trauma. The pain symptoms can usually be treated with icing
down for the first 24 hours, followed by compressive dressings for
a period of two weeks, after which the patient returns to normal
![Page 268: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/268.jpg)
activity. There may be a recurrence of these clinical symptoms once
or twice a year. Sometimes repeated hemorrhage into an intra-
muscular hemangioma can result in fibrotic contracture with
deformity of the adjacent joint that might require a surgical release
to correct the deformity. An example of this is equinous deformity
of the foot caused by a hemangioma of the gastroc muscle. In the
past, attempts have been made to eradicate these larger tumors in
muscle with embolization technique, attempting to occlude the feeder
vessels. This can lead to compartment syndrome, severe contractures
and loss of muscle strength that can be more severe a disability than
the original lesion. Wide surgical resection is extremely difficult
because of the poorly defined margin to the hemangioma and, as a
result, local recurrence is common, followed by intramuscular
hemorrhage and associated pain. In some cases with very large
hemangiomas, amputation is indicated when severe loss of function
occurs. It is extremely rare for a malignant conversion to occur
within a benign vascular dysplasia.
![Page 269: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/269.jpg)
CLASSIC
Case #292
14 year female
hemangioma foot
![Page 270: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/270.jpg)
AP x-ray showing
phleboliths
![Page 271: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/271.jpg)
Lateral x-ray showing more phleboliths
![Page 272: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/272.jpg)
Axial T-1 MRI
tumor
![Page 273: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/273.jpg)
Axial T-2 MRI
tumor
![Page 274: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/274.jpg)
Gross specimen with hemorrhagic cysts
![Page 275: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/275.jpg)
Photomic
![Page 276: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/276.jpg)
Case #293
36 year female
hemangioma hand
![Page 277: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/277.jpg)
X-ray showing calcifying mass
![Page 278: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/278.jpg)
AP and oblique views
![Page 279: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/279.jpg)
Surgical removal
![Page 280: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/280.jpg)
Photomic showing cavernous vascular spaces
![Page 281: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/281.jpg)
Case #293.1
57 year female with
tender mass under
volar aspect of 3rd
MP joint for years
Hemagioma of hand
![Page 282: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/282.jpg)
Axial T-1 prox phalanges T-2
Gad PD metacarpal heads
![Page 283: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/283.jpg)
Cor T-1 T-2
Gad
![Page 284: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/284.jpg)
Cor T-1 T-2
Gad
![Page 285: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/285.jpg)
Case #293.2
52 year old female with
tender lump beneath 2nd
MP joint for years
Hemagioma hand
![Page 286: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/286.jpg)
Cor T-1 T-2 FS
Gad
![Page 287: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/287.jpg)
Axial T-1 T-2 FS
Gad
![Page 288: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/288.jpg)
Gad
47 year old male with long
history intermittent painful
swelling palm of hand
Case #293.3 Tenosynovial Hemangioma Hand
Cor T-1 T-2
![Page 289: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/289.jpg)
Axial T-1
Gad
![Page 290: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/290.jpg)
Case #294
30 year female with hemangioma hand
![Page 291: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/291.jpg)
Case #295
8 year female with
hemangioma distal arm
phlebolith
![Page 292: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/292.jpg)
Lateral view
![Page 293: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/293.jpg)
Coronal T-1 MRI Coronal T-2 MRI
![Page 294: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/294.jpg)
Sagittal T-1 MRI Sagittal T-2 MRI
![Page 295: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/295.jpg)
Axial T-1 MRI Axial T-2 MRI
![Page 296: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/296.jpg)
Photomic showing large vascular spaces
bone
![Page 297: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/297.jpg)
Case #295.1 Recurrent hemangioma
24 year female with recurrent hemangioma triceps
phleboliths
![Page 298: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/298.jpg)
Coronal T-1 T-2
![Page 299: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/299.jpg)
Sagittal T-1 T-2
![Page 300: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/300.jpg)
Axial
T-1
T-2
Gad
![Page 301: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/301.jpg)
Case #295.2
16 year female with tender mass in posterior arm for years
Cor CT Axial CT
Hemagioma triceps m
![Page 302: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/302.jpg)
Cor T-1 T-2 Gad
![Page 303: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/303.jpg)
Axial PD Gad
![Page 304: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/304.jpg)
Sag PD Gad
![Page 305: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/305.jpg)
Case #296
24 year female with hemangioma forearm with phleboliths
![Page 306: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/306.jpg)
Case #297
6 year female
hemangioma forearm
phlebolith
![Page 307: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/307.jpg)
Case #297.1
18 year old female with forearm mass for years
Cor T-1 Gad
Hemangioma forearm
![Page 308: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/308.jpg)
Axial T-1
Axial Gad
![Page 309: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/309.jpg)
Case #297.2
46 yr male with
tender soft mass
forearm for years
Hemangioma forearm
![Page 310: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/310.jpg)
Cor T-1 T-2 Gad
![Page 311: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/311.jpg)
Sag T-1 T-2 Gad
![Page 312: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/312.jpg)
Axial T-1 T-2
Gad
![Page 313: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/313.jpg)
Case #298
10 year female with a
hemangioma distal
leg and foot
Sagittal T-2 MRI
![Page 314: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/314.jpg)
Axial T-2 MRI
![Page 315: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/315.jpg)
Sagittal T-1 MRI foot
![Page 316: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/316.jpg)
Sagittal T-2 MRI
![Page 317: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/317.jpg)
Axial T-2 MRI
![Page 318: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/318.jpg)
Case #298.1 Hemangioma Ankle Sag Gad
52 yr female with 30 year history of intermittent pain in ankle
![Page 319: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/319.jpg)
Cor T-1 T-2 FS Gad
![Page 320: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/320.jpg)
Axial T-1 T-2 FS
Gad
![Page 321: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/321.jpg)
Surgical resection
![Page 322: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/322.jpg)
Case #298.1
15 year male with tender
mass lateral side of forefoot
for many years
Hemangioma
![Page 323: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/323.jpg)
Axial T-1
T-2
![Page 324: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/324.jpg)
Sag T-1
T-2
![Page 325: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/325.jpg)
Cor T-2
![Page 326: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/326.jpg)
Case #1204
22 year male with
hemangioma anterior
compartment leg with
subadjacent cortical
hypertrophy of tibia
![Page 327: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/327.jpg)
Axial gad
contrast MRI
![Page 328: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/328.jpg)
Coronal T-1 MRI
![Page 329: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/329.jpg)
Case #1204.1
31 year female with soft swelling in leg for many years
![Page 330: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/330.jpg)
Cor Ct
Axial CT
![Page 331: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/331.jpg)
Cor T-2 Sag Gad Sag Gad
![Page 332: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/332.jpg)
Axial Gad Axial Gad
![Page 333: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/333.jpg)
Case #1205
38 year female with
hemangioma forearm
with hypertrophic response
in subadjacent ulna
![Page 334: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/334.jpg)
Bone scan
![Page 335: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/335.jpg)
Axial PD MRI
bone hypertrophy
![Page 336: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/336.jpg)
Axial gad contrast MRI
![Page 337: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/337.jpg)
Sagittal T-2 MRI
![Page 338: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/338.jpg)
Case #1206
31 year female with
hemangioma leg with
hypertrophic response
in adjacent fibula
![Page 339: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/339.jpg)
Axial T-2 MRI
![Page 340: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/340.jpg)
Coronal T-1 MRI
![Page 341: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/341.jpg)
Case #1207
25 year female with hemangioma buttock area
tumor calcification
![Page 342: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/342.jpg)
Coronal T-1 MRI
![Page 343: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/343.jpg)
Sagittal T-2 MRI
![Page 344: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/344.jpg)
Case #1207.1
65 year old female
with tender lump in
buttock for 1 year
Axial T-1 T-2
Gad
Hemangioma
buttock
![Page 345: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/345.jpg)
Cor T-2
Sag T-2
![Page 346: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/346.jpg)
CT scan
Pet scan
![Page 347: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/347.jpg)
Case #1208
28 year female with hemangioma gastroc muscle
tumor calcification
![Page 348: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/348.jpg)
Sagittal T-1 MRI
![Page 349: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/349.jpg)
Axial T-1 MRI
![Page 350: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/350.jpg)
Case #1208.1
Axial CT scan Sag
43 year old female with tender lump in medial gastroc for years
![Page 351: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/351.jpg)
Axial T-2 Gad
![Page 352: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/352.jpg)
Sag T-1 Gad
![Page 353: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/353.jpg)
Case #1208.2 Sag T-1 PD FS Gad
16 year female with intermittent pain and swelling in calf for years
second to hemagioma of the gastroc muscle
![Page 354: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/354.jpg)
Axial T-1 T-2
Gad
![Page 355: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/355.jpg)
Case #1209
17 year male with
hemangioma in
quadriceps muscle
Axial T-2 MRI
![Page 356: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/356.jpg)
Case #1210
14 year female with
hemangioma hind foot
Axial T-2 MRI
![Page 357: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/357.jpg)
Case #1211
67 year female with
synovial hemangioma
hip joint with secondary
erosion of femoral
head and neck
![Page 358: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/358.jpg)
Synovial biopsy showing numerous vascular spaces
![Page 359: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/359.jpg)
4 year male with painless mass below the patella 1 yr
Case #1211.1 Synovial hemangioma knee
![Page 360: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/360.jpg)
Sagittal T-1 Sagittal T-2
![Page 361: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/361.jpg)
Axial T-1 Axial T-2 Axial Gad
![Page 362: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/362.jpg)
Case #1211.2
15 year male with knee pain for 6 months
Synovial hemagioma knee
![Page 363: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/363.jpg)
Coronal T-1 Coronal T-2
![Page 364: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/364.jpg)
Axial T-2
![Page 365: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/365.jpg)
Surgical exposure at time of excisional biopsy
![Page 366: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/366.jpg)
Case #1211.3
68 year old female with soft mass medial knee for years
Synovial hemangioma knee
![Page 367: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/367.jpg)
Cor T-1 T-2
Gad
![Page 368: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/368.jpg)
Sag PD Gad
![Page 369: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/369.jpg)
Axial T-2 Gad
![Page 370: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/370.jpg)
Hemangiomatosis
![Page 371: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/371.jpg)
CLASSIC
Case #299
Stillborn with extensive
hemangiomatosis
![Page 372: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/372.jpg)
Upper body showing disappearing bones
![Page 373: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/373.jpg)
Lower half of body
![Page 374: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/374.jpg)
Lower extremity with
disappearing bones
in hemangiomatosis
![Page 375: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/375.jpg)
Case #300
25 year female
hemangiomatosis
upper extremity with
disappearing bones
phleboliths
![Page 376: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/376.jpg)
Case #1212
34 year female with hemagiomatosis forearm
phleboliths
![Page 377: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/377.jpg)
Case #1212.1
39 year male with extensive hemangiomatosis thigh
![Page 378: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/378.jpg)
![Page 379: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/379.jpg)
Coronal T-1
![Page 380: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/380.jpg)
MRI
arteriogram
![Page 381: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/381.jpg)
Lymphangiomas
![Page 382: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/382.jpg)
Lymphangioma
The Lymphangioma, like the hemangioma, is a hamartomatous
dysplastic lesion of soft tissue that arises from the endothelial tube.
Instead of being filled with blood like in the hemangioma, the lymph-
angioma is filled with lymphatic fluid, but otherwise it has a very
similar histological appearance. 90% of these lesions will occur
before the age of two years. There is no sex predominance and the
most common locations are the head and neck, axilla, inguinal area
and, in some cases, the abdominal viscera including the liver and
spleen. Lymphangiomas can be classified as either the capillary type
or simplex type which are considered cutaneous lesions. Larger,
deeper lesions are usually cavernous or cystic in nature and referred
to as cystic hygromas.
![Page 383: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/383.jpg)
CLASSIC
Case #301
23 year female
lymphangioma forearm
and hand with
thumb gigantism
![Page 384: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/384.jpg)
Surgical specimen from forearm
![Page 385: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/385.jpg)
Photomic showing lymphatic channels
![Page 386: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/386.jpg)
Case #302
7 month male
lymphangioma
elbow
![Page 387: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/387.jpg)
Coronal T-1 MRI
![Page 388: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/388.jpg)
Axial T-2 MRI
![Page 389: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/389.jpg)
Case #303
10 year female with lymphangioma forearm
![Page 390: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/390.jpg)
Axial proton density MRI
fluid cyst
![Page 391: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/391.jpg)
Axial T-2 MRI
![Page 392: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/392.jpg)
Case #304 Axial T-1 MRI
21 year female with lymphangioma inguinal area
![Page 393: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/393.jpg)
Axial T-1 MRI more distal
![Page 394: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/394.jpg)
Axial T-1 MRI even more distal
![Page 395: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/395.jpg)
Surgical specimen cut in path lab
![Page 396: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/396.jpg)
Photomic with lymphatic channels
![Page 397: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/397.jpg)
Case #304.1
Gad
8 yr old male with soft mass
over buttock for years with
intermittent clear serous fluid
drainage
Cor T-1 T-2
Lymphangioma Buttock
![Page 398: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/398.jpg)
Axial T-1 Axial T-2
Axial Gad Sag T-2
![Page 399: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/399.jpg)
Case #1213
46 year male with
lymphangioma arm
Axial PD MRI
![Page 400: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/400.jpg)
Another T-2 MRI
showing 2 lesions
![Page 401: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/401.jpg)
Coronal T-2 MRI
showing lymphangioma
next to cephalic vein
vein
![Page 402: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/402.jpg)
Sagittal T-2 MRI
showing hygroma
next to brachial
vessels
vessels
![Page 403: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/403.jpg)
Photomic of lymphangioma
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Glomus Tumor
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Glomus Tumor The glomus tumor and the hemangiopericytoma are vascular
tumors that arise from the hemangiopericyte which is a cell at the
periphery of the capillary vascular network whose normal function
is to regulate the flow of blood thru the capillary tube system. There-
fore, these are tumors that arise from cells outside the endothelial
tube where hemangiomas originate from endothelial cells. The
glomus tumor is a small and usually subcutaneous tumor measuring
less than 1 cm in diameter and represents 1.6% of all soft tissue
tumors. It occurs equally in men and women between the ages of
20 and 40 years. The most common location for the glomus tumor
is in the subungual area of a digit where it is readily visible,
exquisitely tender on palpation and has a reddish-purple color.
Subcutaneous glomus tumors that occur in the hand, wrist, forearm
and foot area are invisible to physical diagnosis and characteristically
present with localized lancinating pain that persists in the exact
location of origin until treated by minimal wide surgical resection.
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CLASSIC Case #305
50 year male with glomus tumor thumb
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AP x-ray
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Surgical removal
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Photomic showing hemangiopericytes
blood
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Case #306
45 year female with glomus tumor web space hand
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Case #307
Surgical exposue subcutaneous glomus tumor
forearm 45 year female
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Hemangiopericytoma
![Page 413: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/413.jpg)
Hemangiopericytoma
The hemangiopericytoma arises from the same hemangiopericytes
in the capillary system but is a larger tumor seen in more proximal
areas, usually a deep tumor in muscle bellies about the thigh or
retroperitoneal area of the pelvis. The smaller tumors are usually
benign but the larger, more aggressive pericytomas can be malignant
and therefore deserve more aggressive treatment with wide resection
followed by postoperative radiation therapy because of the chance of
local recurrence.
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CLASSIC Case #308 Sagittal T-1 MRI
87 year female with hemangiopericytoma below groin
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Another sagittal
T-1 MRI
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Axial proton density MRI
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Cut specimen in path lab
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Photomic
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Case #309 Coronal T-1 MRI
45 year male with hemangiopericytoma thigh
![Page 420: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/420.jpg)
Axial T-1 MRI
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Axial proton density MRI
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Axial T-2 MRI
tumor
![Page 423: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/423.jpg)
Case #310 Axial T-1 MRI
44 year female with hemgiopericytoma thigh
![Page 424: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/424.jpg)
Axial T-2 MRI
tumor
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Sagittal T-2 MRI
tumor
![Page 426: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/426.jpg)
Case #311
58 year female
malignant hemangiopericytoma
arm
![Page 427: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/427.jpg)
Coronal T-1 MRI
tumor
![Page 428: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/428.jpg)
Coronal proton density MRI
tumor
![Page 429: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/429.jpg)
Axial proton
density MRI
tumor
![Page 430: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/430.jpg)
Kaposi’s Sarcoma
![Page 431: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/431.jpg)
Kaposi’s Sarcoma
Kaposi’s sarcoma is considered to be the most common of all
soft tissue malignant vascular tumors and can be divided into the
chronic, lymphadenopathic, transplant associated type, and the
AIDS-related type. It is a cutaneous angiosarcoma seen just beneath
the skin, presenting with a characteristic purplish-blue appearance,
similar to a cutaneous hemangioma. It occurs most commonly in
men and is endemic in Central Africa where AIDS is very prevalent.
The most frequent location for the Kaposi’s sarcoma is in the foot
and ankle area. Microscopically, the tumor has an aggressive
vascular pattern but with rare mitoses. However, over a period of
years the tumor can develop into a high grade angiosarcoma or even
fibrosarcoma. The overall mortality runs between 10 and 20%. The
treatment usually consists of local radiation therapy or surgical
resection if the lesion is localized.
![Page 432: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/432.jpg)
Case #312
75 year female with Kaposi’s sarcoma foot
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Plantar view
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Cut resected specimen
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Photomic
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Case #313
65 year male with Kaposi’s sarcoma foot
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Photomic
![Page 438: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/438.jpg)
Angiosarcoma
![Page 439: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/439.jpg)
Angiosarcoma
The soft tissue angiosarcoma is an extremely rare soft tissue
tumor, accounting for less than 1% of all sarcomas. It is usually
a cutaneous lesion that affects males more often than females. It
can be deeply located, seen typically in the upper extremities
of women who have had chronic lymphedema following radical
breast surgery and radiation therapy. The high grade angiosarcoma
is not a very bloody tumor and does not have the typical vascular
spaces seen in benign vascular tumors or low grade intermediate
angiosarcomas. The prognosis for the high grade angiosarcoma is
very poor, especially for older people, and the treatment usually
consists of wide local resection and postoperative radiation
therapy.
![Page 440: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/440.jpg)
CLASSIC Case #314 Sagittal proton density MRI
30 year male with high grade angiosarcoma heel
![Page 441: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/441.jpg)
Coronal T-2 MRI
![Page 442: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/442.jpg)
Sagittal proton density MRI
Metastasis to inguinal lymph node
![Page 443: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/443.jpg)
Sagittal T-2 MRI of positive lymph node
![Page 444: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/444.jpg)
Low power photomic
![Page 445: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/445.jpg)
Higher power showing pleomorphic giant cells
around vascular spaces
![Page 446: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/446.jpg)
Case #314.1
52 yr old male with
tender mass in proximal
anterior thigh area 3 mos
Angiosarcoma Thigh
![Page 447: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/447.jpg)
Axial T-1 STIR
![Page 448: Vol 15 ppt](https://reader030.vdocuments.mx/reader030/viewer/2022012913/54b807054a79596e108b45da/html5/thumbnails/448.jpg)
Cor STIR Sag STIR