Superficial Soft Tissue Masses Research Articles

Bilateral Asymmetric Superficial Soft Tissue Masses With Extensive Involvement of Both Upper Extremities

Bilateral Asymmetric Superficial Soft Tissue Masses With Extensive Involvement of Both Upper Extremities

Differentiation of Benign and Malignant Superficial Soft-tissue Masses Using Grayscale and Color Doppler Ultrasonography

This study was performed to evaluate the usefulness of high-resolution grayscale and color Doppler ultrasound to distinguish benign from malignant soft-tissue masses on the basis of ultrasonographic patterns. We enrolled 398 female and 420 male patients aged 1-104 years (mean, 49.8 years). All presented with a palpable nodule or mass located superficially in the body. Each lesion was examined by grayscale and color Doppler ultrasonography to assess its echogenicity, margin, shape, composition, acoustic transmission, size and other patterns. Spectral Doppler was applied in lesions with positive color flow signals. The nature of all masses was confirmed by aspiration cytology, biopsy, surgical pathology or long-term clinical follow-up. There were a total of 693 benign and 125 malignant masses. Five malignant and 14 benign histologies (including 6 types with inflammation-related, hematoma or pseudoaneurysm) occurred that had more than 10 subjects with each histology. Eight benign histopathologies included cysts, neoplasms, vascular and miscellaneous. Five malignant histologies included metastases, osteogenic sarcomas, lymphomas, malignant fibrous histiocytomas and liposarcomas. There were significant differences (p < 0.05) between the benign and malignant soft-tissue tumors in terms of parameters including tumor margin, shape and size. Benign lesions did not have infiltrated margins or a scalloped shape and malignant tumors tended to be large. However, there was no significant difference (p > 0.05) between the benign and malignant soft-tissue tumors in terms of echogenicity, composition and color Doppler features. Ultrasonography with color Doppler imaging is a good modality for characterizing most soft-tissue masses, and tumor size > 5 cm and having infiltrated margin highly suggests malignancy.

Case Report: Kaposiform Hemangioendothelioma in Multiple Spinal Levels Without Skin Changes

Kaposiform hemangioendothelioma is a rare vascular tumor of childhood that is locally aggressive but has little metastatic potential and by itself is not known to be lethal. It most commonly presents as a superficial or deep soft tissue mass with associated cutaneous lesions. Kasabach-Merritt phenomenon, a condition characterized by profound thrombocytopenia and life-threatening hemorrhage, often is associated with kaposiform hemangioendothelioma. Six cases of kaposiform hemangioendothelioma have been reported in bone, two of which were located in extracraniofacial bones. We report a diagnostically challenging case of a 6-year-old girl with kaposiform hemangioendothelioma of the thoracolumbar spine without Kasabach-Merritt phenomenon or cutaneous lesions.

Bilateral asymmetric superficial soft tissue masses with extensive involvement of both upper extremities: demonstration of Kimura’s disease by US and MRI (2008: 12b)

Kimura's disease is known as a rare chronic inflammatory disease occurring mainly in the head and neck regions of Asian male patients. We present a case of Kimura's disease with extensive involvement of the bilateral upper extremities in a 20-year-old Korean man. Ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated the presence of partially ill-defined, conglomerated soft tissue masses centered in the subcutaneous layer of both upper arms, with cranial extension along the cutaneous nerve in the right lesion. Medial epitrochlear, axillary and lower cervical lymphadenopathy accompanied the masses.

Ultrasound evaluation of superficial soft-tissue masses in paediatric patients – are we able to distinguish malignant tumours from benign masses?

Aims: The ultrasound seems to be the most suitable method for evaluation in children with soft tissue masses. It provides information about presence, size, location, structure and the margins of the lesion. The aim of this study was to prove the usefulness of US in distinguishing different malignant tumors from benign masses in soft tissues.

Superficial Soft-Tissue Masses: Analysis, Diagnosis, and Differential Considerations

A wide variety of superficial soft-tissue masses may be seen in clinical practice, but a systematic approach can help achieve a definitive diagnosis or limit a differential diagnosis. Superficial soft-tissue masses can generally be categorized as mesenchymal tumors, skin appendage lesions, metastatic tumors, other tumors and tumorlike lesions, or inflammatory lesions. With regard to their imaging features, these masses may be further divided into lesions that arise in association with the epidermis or dermis (cutaneous lesions), lesions that arise within the substance of the subcutaneous adipose tissue, or lesions that arise in intimate association with the fascia overlying the muscle. The differential diagnosis may be limited further by considering the age of the patient, anatomic location of the lesion, salient imaging features, and clinical manifestations.

Incidental Finding during Venous Duplex Examination: Solitary Fibrous Tumor or Arteriovenous Malformation in the Left Lower Extremity

Purpose —Superficial varicosities surrounding a palpable mass in the posterior aspect of the left thigh were investigated during a venous duplex examination. A well-defined mass with arterial and venous feeding branches strongly suggested the presence of an arteriovenous malformation. We present an unusual case of a soft-tissue thigh mass that appeared to be an arteriovenous malformation by ultrasound and arteriography but after surgical resection was confirmed to be a benign soft tissue tumor. Case Report —A 32-year old woman presented with superficial varicosities surrounding a painful mass on the posterior aspect of her left thigh. Venous duplex exam demonstrated normal findings of the deep veins, but further investigation of the superficial varicosities revealed a 3.5-cm x 6.0-cm soft-homogenous mass with a large complex network of arterial and venous feeding branches. Arteriography confirmed a well-defined thigh mass with an arterial network feeding the mass. Surgical resection of this well-circumscribed mass was performed. Histological tissue exam revealed a benign low-grade spindle cell neoplasm with blood vessels. Conclusion —This report highlights the importance of evaluating all abnormal superficial varicosities and palpable soft-tissue masses as part of a lower extremity vascular duplex evaluation because incidental findings not diagnosed through clinical examination may be detected.

Superficial Soft-Tissue Masses of the Extremities

Superficial soft-tissue masses are among the most common indications for imaging of the extremities. A broad array of benign and malignant processes may be manifested in palpable cutaneous or subcutaneous masses or nodules. Most such lesions are treated with surgical excision, but some may be conservatively managed. The lesions can be differentiated according to their location in one or more skin layers (epidermis, dermis, and subcutis), their histologic composition, and the associated anatomic abnormality or disease process. Because the imaging characteristics of many benign soft-tissue lesions overlap with those of malignant ones, knowledge of the patient's clinical history (including any laboratory test results) and direct visual examination of the lesion often are important for differentiation. Histologic analysis may be necessary to achieve a definitive diagnosis.

Chronic, reactive conditions of the oral cavity simulating mucosal carcinomas: CT and MR imaging findings with pathologic correlation in five patients

To investigate the radiologic and pathologic findings of chronic, inflammatory, reactive conditions of the oral cavity, which clinically and radiologically simulate mucosal malignancy, computed tomography (CT; n=4) and magnetic resonance (MR; n=2) images, as well as surgical specimens, obtained from five patients with surgically proved, chronic inflammatory mass of the oral cavity were retrospectively reviewed. All patients had a palpable mass or ulcerative lesion in the oral cavity. On CT and MR images, all three lesions in the oral tongue and one lesion in the retromolar trigone were seen as a superficial, ill-marginated, well-enhancing ellipsoid or focal soft tissue mass. Pathologic examinations revealed various depths and degrees of acute and chronic inflammation, granulation tissue, and fibrosis in the subepithelial stroma, accompanied by pseudoepitheliomatous hyperplasia in these four patients. In the remaining one patient with lesion in the hard palate, CT showed a relatively well-marginated, well-enhancing soft tissue mass, which histologically proved to be irritation fibroma. Neither clinical nor radiologic manifestations could afford clues to make the correct diagnosis, which therefore should rely on histology. Some forms of chronic, inflammatory, reactive conditions of the oral cavity are nearly indistinguishable from the malignant tumors both clinically and radiologically. Knowledge of this entity may obviate the unnecessary and somewhat disfiguring operation.

Clinico‐pathologic correlations of myofibroblastic tumors of the oral cavity: 1. nodular fasciitis

Nodular fasciitis (NF), a soft tissue lesion mainly composed of myofibroblastic cells, is well documented in various body locations however, in the oral cavity it is rare. The NF has non-specific histologic characteristics that might result in misdiagnosis and mistreatment. The aim of the study was to analyze clinico-pathologic correlations of NF occurring in the oral cavity. A total of 36 cases of oral NF were analyzed including review of the English language literature and five new cases from our files. Oral mucosa NF was found to peak in the fourth and fifth decades, which is a decade later than NF occurring in other sites of the body. The most common locations were the buccal mucosa (52.8%) and the lips (16.7%). Duration of lesions ranged from 3 days to 2 years, with approximately 61% being present for more than a month, which is longer than the duration of NF from other body locations. Histologically, oral NF showed varying degrees of cellularity and frequently contained myxomatous areas, and often demonstrated local infiltration into adjacent tissues. However, the myofibroblastic, spindle-shaped lesional cells were uniform and lacked any major signs of atypia. Mitotic figures, characteristically abundant in NF lesions throughout the body, ranged from absent to moderately high in oral NF cases. Treatment modality of choice was complete surgical excision. Recurrence was reported for only one case. Extensive, mutilating surgical procedures for oral mucosa NF are unnecessary, since lesions resolve even when surgical margins are partly involved. The NF should be included in the clinical differential diagnosis of superficial and deep soft tissue masses of the oral cavity, especially of the buccal mucosa. Histopathologically, NF should be differentiated from other spindle cell lesions, mainly myofibroma, neurofibroma, fibrosarcoma, solitary fibrous tumor, fibromatosis and fibrous histiocytoma.

Clinically unsuspected foreign bodies: the importance of sonography.

To show the value of sonography in the detection of clinically unsuspected foreign bodies appearing as soft tissue masses. High-resolution B-mode and color Doppler sonography was performed in 288 patients referred with superficial soft tissue masses over a period of 2 years. In 8 lesions in 6 patients, sonography showed small curved or linear echogenic structures surrounded by hypoechoic masses characteristic of foreign bodies with granulation tissue. One lesion had increased vascularity on color Doppler sonography. Patients were referred for other imaging studies, including magnetic resonance imaging, computed tomography, and bone and labeled red blood cell scintigraphy, which did not add relevant information. Three patients underwent surgery; foreign bodies were found in 2, and infected granulation tissue was found in 1. Spontaneous resolutions and no growth of the lesions were seen in the other 2 patients. The possibility of a foreign body should be considered when scanning soft tissue masses even in the absence of a relevant clinical history. Once a foreign body is diagnosed, no further workup is indicated.

Primary aneurysm of the basilic vein

This is a report of a 71-year-old woman who presented with a superficial soft tissue mass in the antecubital fossa. Excision was undertaken under local anaesthesia. The lesion proved to be a primary aneurysm of the basilic vein. Reviewing the literature we found only a few previous reports of primary venous aneurysms in the upper extremities.

Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography.

We describe the sonographic appearance and vascularization of hemangiomas and determine if vessel density and peak systolic Doppler shifts distinguish hemangiomas from other superficial soft-tissue masses. Our pilot study included 20 infants and children with hemangiomas who were to undergo biopsy before treatment with interferon alpha-2b. We used Doppler sonography to determine the number of vessels per square centimeter, peak arterial Doppler shift, resistive index, and signs of arteriovenous shunting. All hemangiomas showed high vessel density (more than five per square centimeter) and high Doppler shifts (more than 2 kHz), and these two factors became our diagnostic criteria. A prospective study of 116 patients was then carried out. One hundred sixteen consecutive pediatric patients with superficial soft-tissue masses were examined using Doppler sonography; sonographic findings were compared with the final diagnoses that were established by biopsy, CT, or clinical follow-up. The final diagnoses included 70 hemangiomas, 20 venous malformations, three arteriovenous malformations, three arteriolocapillary malformations, and 20 other masses. Fifty-nine lesions showing high vessel density (more than five per square centimeter) and a peak arterial Doppler shift exceeding 2 kHz were correctly diagnosed as hemangiomas (sensitivity, 84%; specificity, 98%). One arteriovenous malformation showed high vessel density and high Doppler shifts, but none of the other masses that were not hemangiomas did. Eleven patients with hemangiomas who were being treated with interferon at the time of the study fulfilled only one of the two diagnostic criteria. High vessel density and high peak arterial Doppler shift can be used to distinguish hemangiomas from other soft-tissue masses.

SMAS fixation to the facial skeleton: rationale and results.

The trend in modern facial rejuvenation surgery is to reposition the ptosis of the superficial soft-tissue mass relative to the facial skeleton. The logical method of supporting the superficial tissue is to reattach it to the underlying skeleton, thereby replicating the function of the retaining ligaments. Five hundred consecutive face lifts involving deep fixation of the submucosal aponeurotic system flap to the periosteum of the zygoma were reviewed for complications and side effects. Expected complications, such as irregularities, dimpling, and palpable sutures, occurred in fewer than 1 percent of cases, confirming the safety of this method. The conclusion from this experience is relevant to all methods of deep-layer facial rejuvenation surgery, including the endoscopic approach.

Superficial soft-tissue masses suggestive of recurrent malignancy: sonographic localization and biopsy.

We investigated the usefulness of high-resolution sonography to localize superficial soft-tissue masses and to guide needle sampling for recurrent malignancy. High-resolution sonography (10-MHz) was used to locate and guide needle sampling of 16 palpable and eight impalpable superficial masses suggestive of recurrent malignancy in 23 patient (12 men, 11 women; 34-85 years old). After detection, 22 (92%) of the masses were immediately sampled by fine-needle aspiration with 18- to 25-gauge needles and two (8%) were sampled by a 20-gauge core gun. Diagnostic material was obtained without complication from all 24 masses and proved positive for recurrent disease in 13 (54%). Ten (63%) of 16 palpable and three (38%) of eight impalpable masses proved positive for recurrent malignancies. One third of superficial soft-tissue masses were detected by imaging only, and of the masses not revealed on imaging, three (23%) of 13 were the site of first recurrence. Most nonnodal superficial masses (8/13) were benign, unlike the lymph nodes, of which three (27%) of 11 were benign. Not all early recurrent malignancies within the skin and subcutaneous tissues are detected by clinical examination. High-resolution sonography provided us with a rapid, safe, and accurate means of localizing and then guiding needle biopsies of superficial soft-tissue masses suggestive of recurrent malignancy.

Lipoblastoma/lipoblastomatosis: a clinicopathologic study of 25 tumors.

Lipoblastoma/lipoblastomatosis is an uncommon benign adipose tissue tumor of children. Since 1958, 25 of these tumors from 24 patients have been reviewed in the Department of Pathology at The Children's Hospital of Philadelphia. Tumors were resected from 19 boys (79%) and five girls, and 20 patients (84%) were < or =5 years of age at diagnosis. Twenty-three tumors presented as painless superficial soft-tissue masses; one tumor was retroperitoneal and was discovered because of vomiting; one hand tumor was present at birth. Tumors occurred in an extremity (n = 11 patients), the head and neck (n = 5), groin (n = 2), axilla (n = 2), back (n = 1), chest (n = 1), flank (n = 1), labia (n = 1), and retroperitoneum (n = 1). Thirteen tumors occurred on the left side, and five occurred on the right. Lesions measured 1.0-21.0 cm in greatest dimension; 15 of 25 (60%) measured < or =5.0 cm. The largest (retroperitoneal) tumor weighed 450 g. Eleven tumors were discrete lipoblastoma, and 14 had irregular margins (lipoblastomatosis). Microscopically, the tumors displayed adipocytes in different stages of maturation; lobules bordered by septae that were cellular in 11 cases; prominent blood vessels in 19 cases; and myxoid foci in 13 cases. Chart review of 22 patients showed that one tumor recurred 4 years after resection; one tumor recurred after 7 years as fibrolipoma; and one incompletely resected tumor enlarged and at second resection was lipoma. There were no metastases. Three patients also had hemangioma. Juvenile aponeurotic fibroma occurred in one patient near the site of resection of a lipoblastoma 4 years earlier. We conclude that lipoblastoma/lipoblastomatosis behaves benignly, occurs in both superficial and deep sites, occasionally attains large size, may mature, can recur, and may be associated with other benign soft-tissue lesions. Complete surgical excision is the treatment of choice.