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Giant cell tumor of soft tissue: a case with atypical US and MRI findings.

An SB, Choi JA, Chung JH, Oh JH, Kang HS - Korean J Radiol (2008 Sep-Oct)

Bottom Line: We report the case of a giant cell tumor with diffuse interstitial hemorrhaging and unusually prominent cystic components in the soft tissue of the thigh which has not been reported previously.Magnetic resonance image (MRI), showed signal intensity typical of a giant cell tumor.However, because of its conspicuous large well-circumscribed cystic components, the differential diagnoses, based on the image findings from an ultrasonography (US) and MRI, were complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
We report the case of a giant cell tumor with diffuse interstitial hemorrhaging and unusually prominent cystic components in the soft tissue of the thigh which has not been reported previously. Magnetic resonance image (MRI), showed signal intensity typical of a giant cell tumor. However, because of its conspicuous large well-circumscribed cystic components, the differential diagnoses, based on the image findings from an ultrasonography (US) and MRI, were complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst.

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23-year-old woman with giant cell tumor of soft tissue in thigh.A. Sonogram of lateral aspect of right thigh shows primary cyst with debris and hyperechoic nodule (thick arrow). Daughter cyst was located adjacent to main cyst (thin arrow) and is also seen with fluid-fluid levels within.B. Axial T1-weighted image (TR/TE, 430/20) shows cystic mass with intermediate signal intensity (arrow) adjacent to vastus lateralis muscle in subcutaneous tissue of right thigh.C. Axial T2-weighted image (TR/TE, 4039/100) shows cystic mass with low signal intensity, which comprised of two cysts (thick arrows) and solid portion (thin arrow). Note difference in signal intensity between two cysts. Nodule (arrowhead) within large cyst is well visualized.D. Contrast-enhanced T1-weighted image (TR/TE, 500/15) with fat suppression shows diffuse enhancement of cystic wall (arrow) and solid portion (arrowhead) of mass.E. Gross photograph of excised specimen revealing extensive cystic change of mass with dark-brown color.F. Histologic features of giant cell tumor showing cystic change. Cystic wall of this mass shows mixture of mononuclear spindle cells and multinucleated osteoclast-like giant cells (arrows, Hematoxylin & Eosin staining, ×100).G. Immunohistochemical staining for CD68. Tumor cells show diffuse positive reaction in multinucleated giant cells (arrows) and focally in mononuclear spindle cells (×400) for CD68.
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Figure 1: 23-year-old woman with giant cell tumor of soft tissue in thigh.A. Sonogram of lateral aspect of right thigh shows primary cyst with debris and hyperechoic nodule (thick arrow). Daughter cyst was located adjacent to main cyst (thin arrow) and is also seen with fluid-fluid levels within.B. Axial T1-weighted image (TR/TE, 430/20) shows cystic mass with intermediate signal intensity (arrow) adjacent to vastus lateralis muscle in subcutaneous tissue of right thigh.C. Axial T2-weighted image (TR/TE, 4039/100) shows cystic mass with low signal intensity, which comprised of two cysts (thick arrows) and solid portion (thin arrow). Note difference in signal intensity between two cysts. Nodule (arrowhead) within large cyst is well visualized.D. Contrast-enhanced T1-weighted image (TR/TE, 500/15) with fat suppression shows diffuse enhancement of cystic wall (arrow) and solid portion (arrowhead) of mass.E. Gross photograph of excised specimen revealing extensive cystic change of mass with dark-brown color.F. Histologic features of giant cell tumor showing cystic change. Cystic wall of this mass shows mixture of mononuclear spindle cells and multinucleated osteoclast-like giant cells (arrows, Hematoxylin & Eosin staining, ×100).G. Immunohistochemical staining for CD68. Tumor cells show diffuse positive reaction in multinucleated giant cells (arrows) and focally in mononuclear spindle cells (×400) for CD68.

Mentions: The initial sonography revealed a well-circumscribed large cystic mass located in the subcutaneous tissue. It consisted of two cysts; one large main cyst and another daughter cyst. The main cyst was predominantly composed of hypoechoic fluid and debris in the dependent portion within it. Inside the cyst, a hyperechoic nodular lesion was observed. The daughter cyst adjacent to the main cyst also contained debris-like materials (Fig. 1A). A Doppler sonographic examination showed no evidence of a vascular signal, and MRI obtained two months later showed a high signal intensity cystic lesion with a wall of low signal intensity on both the T1- and T2-weighted images. The size of the mass was measured to be about 5.5×4.8×2.4 cm. The daughter cyst had a fluid content at slightly lower signal intensity than the main cyst on a T2-weighted image. A nodular lesion within the main cyst was also observed as low signal intensity on a T2-weighted image, which was similar to the sonographic finding. The solid portion of the mass was directly adjacent to the cysts, and was contiguous with the peripheral wall of the smaller cysts (Figs. 1B, C). With gadolinium enhancement, the solid portion and cystic wall diffusely enhanced in a similar fashion (Fig. 1D). The preoperative differential diagnoses, based on the imaging findings (US and MRI), were a complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst such as a hydatid cyst.


Giant cell tumor of soft tissue: a case with atypical US and MRI findings.

An SB, Choi JA, Chung JH, Oh JH, Kang HS - Korean J Radiol (2008 Sep-Oct)

23-year-old woman with giant cell tumor of soft tissue in thigh.A. Sonogram of lateral aspect of right thigh shows primary cyst with debris and hyperechoic nodule (thick arrow). Daughter cyst was located adjacent to main cyst (thin arrow) and is also seen with fluid-fluid levels within.B. Axial T1-weighted image (TR/TE, 430/20) shows cystic mass with intermediate signal intensity (arrow) adjacent to vastus lateralis muscle in subcutaneous tissue of right thigh.C. Axial T2-weighted image (TR/TE, 4039/100) shows cystic mass with low signal intensity, which comprised of two cysts (thick arrows) and solid portion (thin arrow). Note difference in signal intensity between two cysts. Nodule (arrowhead) within large cyst is well visualized.D. Contrast-enhanced T1-weighted image (TR/TE, 500/15) with fat suppression shows diffuse enhancement of cystic wall (arrow) and solid portion (arrowhead) of mass.E. Gross photograph of excised specimen revealing extensive cystic change of mass with dark-brown color.F. Histologic features of giant cell tumor showing cystic change. Cystic wall of this mass shows mixture of mononuclear spindle cells and multinucleated osteoclast-like giant cells (arrows, Hematoxylin & Eosin staining, ×100).G. Immunohistochemical staining for CD68. Tumor cells show diffuse positive reaction in multinucleated giant cells (arrows) and focally in mononuclear spindle cells (×400) for CD68.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
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Figure 1: 23-year-old woman with giant cell tumor of soft tissue in thigh.A. Sonogram of lateral aspect of right thigh shows primary cyst with debris and hyperechoic nodule (thick arrow). Daughter cyst was located adjacent to main cyst (thin arrow) and is also seen with fluid-fluid levels within.B. Axial T1-weighted image (TR/TE, 430/20) shows cystic mass with intermediate signal intensity (arrow) adjacent to vastus lateralis muscle in subcutaneous tissue of right thigh.C. Axial T2-weighted image (TR/TE, 4039/100) shows cystic mass with low signal intensity, which comprised of two cysts (thick arrows) and solid portion (thin arrow). Note difference in signal intensity between two cysts. Nodule (arrowhead) within large cyst is well visualized.D. Contrast-enhanced T1-weighted image (TR/TE, 500/15) with fat suppression shows diffuse enhancement of cystic wall (arrow) and solid portion (arrowhead) of mass.E. Gross photograph of excised specimen revealing extensive cystic change of mass with dark-brown color.F. Histologic features of giant cell tumor showing cystic change. Cystic wall of this mass shows mixture of mononuclear spindle cells and multinucleated osteoclast-like giant cells (arrows, Hematoxylin & Eosin staining, ×100).G. Immunohistochemical staining for CD68. Tumor cells show diffuse positive reaction in multinucleated giant cells (arrows) and focally in mononuclear spindle cells (×400) for CD68.
Mentions: The initial sonography revealed a well-circumscribed large cystic mass located in the subcutaneous tissue. It consisted of two cysts; one large main cyst and another daughter cyst. The main cyst was predominantly composed of hypoechoic fluid and debris in the dependent portion within it. Inside the cyst, a hyperechoic nodular lesion was observed. The daughter cyst adjacent to the main cyst also contained debris-like materials (Fig. 1A). A Doppler sonographic examination showed no evidence of a vascular signal, and MRI obtained two months later showed a high signal intensity cystic lesion with a wall of low signal intensity on both the T1- and T2-weighted images. The size of the mass was measured to be about 5.5×4.8×2.4 cm. The daughter cyst had a fluid content at slightly lower signal intensity than the main cyst on a T2-weighted image. A nodular lesion within the main cyst was also observed as low signal intensity on a T2-weighted image, which was similar to the sonographic finding. The solid portion of the mass was directly adjacent to the cysts, and was contiguous with the peripheral wall of the smaller cysts (Figs. 1B, C). With gadolinium enhancement, the solid portion and cystic wall diffusely enhanced in a similar fashion (Fig. 1D). The preoperative differential diagnoses, based on the imaging findings (US and MRI), were a complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst such as a hydatid cyst.

Bottom Line: We report the case of a giant cell tumor with diffuse interstitial hemorrhaging and unusually prominent cystic components in the soft tissue of the thigh which has not been reported previously.Magnetic resonance image (MRI), showed signal intensity typical of a giant cell tumor.However, because of its conspicuous large well-circumscribed cystic components, the differential diagnoses, based on the image findings from an ultrasonography (US) and MRI, were complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
We report the case of a giant cell tumor with diffuse interstitial hemorrhaging and unusually prominent cystic components in the soft tissue of the thigh which has not been reported previously. Magnetic resonance image (MRI), showed signal intensity typical of a giant cell tumor. However, because of its conspicuous large well-circumscribed cystic components, the differential diagnoses, based on the image findings from an ultrasonography (US) and MRI, were complicated epidermoid cyst, cystic change of a neurogenic tumor, and a parasitic cyst.

Show MeSH
Related in: MedlinePlus