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Radiological findings of malignant peripheral nerve sheath tumor: reports of six cases and review of literature.

Yu YH, Wu JT, Ye J, Chen MX - World J Surg Oncol (2016)

Bottom Line: Location, size, shape, signal or density, boundary, bone destruction, relation to adjacent nerve, contrast-enhanced features as well as some other signs were assessed and compared with statistical software.A P value ≤0.05 was considered to be statistically significant.Peripheral enhancement with non-cystic appearance or remarkable heterogeneous enhancement may be useful for differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Imaging, Subei People's Hospital of Jiangsu Province, 98# Western Nantong Road, Yangzhou, 225001, China.

ABSTRACT

Background: Malignant peripheral nerve sheath tumor (MPNST) is a kind of rare neurogenic tumor. If associated with neurofibromatosis type 1, MPNST usually has a higher mortality. The aim of the article is to assess the imaging characteristics of MPNST and compare them with those of benign peripheral nerve sheath tumor (BPNST) to characterize this tumor.

Methods: Clinical and imaging data of six cases with MPNST and 28 cases with BPNST in our institution since 2011 were retrospectively reviewed. Thirty-three patients have available MR imaging data, and two patients of MPNST also accepted CT scan. One patient accepted CT scan only. Location, size, shape, signal or density, boundary, bone destruction, relation to adjacent nerve, contrast-enhanced features as well as some other signs were assessed and compared with statistical software. Student's t test was used for comparison of continuous variables. Fisher's exact test was used for analysis of nominal variable. A P value ≤0.05 was considered to be statistically significant.

Results: Differences existed between two groups in tumor size ((7.2 ± 3.3)cm in MPNST vs. (3.8 ± 1.4)cm in BPNST), unclear margin (4/6 in MPNST vs. 1/28 in BPNST), eccentricity to the nerve (1/6 in MPNST vs. 21/28 in BPNST), intratumoral lobulation (4/6 in MPNST vs. 2/28 in BPNST), peritumoral edema (3/6 in MPNST vs. 0 in BPNST), and peripheral enhancement (4/6 in MPNST (three of five MR, one CT) vs. 4/28 in BPNST). Bone destruction was observed in one MPNST.

Conclusions: MR imaging is a valuable, non-invasive modality for the diagnosis of MPNST. Peripheral enhancement with non-cystic appearance or remarkable heterogeneous enhancement may be useful for differential diagnosis. Other imaging features such as large size (over 5 cm in diameter), ill-defined margin, intratumoral lobulation, peritumoral edema, and adjacent bone destruction are also supportive of MPNST.

No MeSH data available.


Related in: MedlinePlus

(D1) A huge, well-margined retroperitoneal MPNST is shown on enhanced CT scan, with feeding vessels inside. (D2) On the lower level, a hypo-attenuated foci can be observed, which was turned out to be a myxoid cyst
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Fig4: (D1) A huge, well-margined retroperitoneal MPNST is shown on enhanced CT scan, with feeding vessels inside. (D2) On the lower level, a hypo-attenuated foci can be observed, which was turned out to be a myxoid cyst

Mentions: In MPNST group, four of five (80 %) tumors exhibited hypo-intense on T1-weighted images (T1WI) and hyper-intense signal on T2-weighted images (T2WI), and only one tumor demonstrated mixed signal on T1 and T2WI because of hemorrhage (Fig. 1 A2, A3). Two NF-1 associated tumors showed more complex signal on T2WI than other tumors (Figs. 2 B2, 3 C2). While in BPNST group, 20 (71.4 %) tumors were hypo-intense on T1WI and hyper-intense signal on T2WI, 2 (7.2 %) were mixed-intense signal, and 6 (21.4 %) were iso-intense on T1WI and hyper-intense signal on T2WI. Homogeneity of T1WI can be seen in 10 BPNSTs and 4 MPNSTs, whereas homogeneity of T2WI can only be seen in 1 BPNST. Typical target sign can be observed in five cases of BPNST but absent in all MPNST cases. Adjacent soft tissue swelled and exhibited hyper-intense signal on T2WI only in three cases of MPNST (Fig. 2 B2). On plain CT scan, density of tumors tended to be similar to that of the muscle. In a facial MPNST, calcification, hemorrhage, and adjacent bone erosion can be found (Fig. 1 A1). Enhancing pattern on CT and MR was much alike. After contrast administration, MPNST showed peripheral enhancement (Figs. 1 A4, 4 D2) (three of five MR, one CT) or irregular enhancement (Fig. 3 C3) (two of five MR). Peripheral enhancement was seen more often in MPNST than in BPNST (4 of 28).Fig. 1


Radiological findings of malignant peripheral nerve sheath tumor: reports of six cases and review of literature.

Yu YH, Wu JT, Ye J, Chen MX - World J Surg Oncol (2016)

(D1) A huge, well-margined retroperitoneal MPNST is shown on enhanced CT scan, with feeding vessels inside. (D2) On the lower level, a hypo-attenuated foci can be observed, which was turned out to be a myxoid cyst
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862189&req=5

Fig4: (D1) A huge, well-margined retroperitoneal MPNST is shown on enhanced CT scan, with feeding vessels inside. (D2) On the lower level, a hypo-attenuated foci can be observed, which was turned out to be a myxoid cyst
Mentions: In MPNST group, four of five (80 %) tumors exhibited hypo-intense on T1-weighted images (T1WI) and hyper-intense signal on T2-weighted images (T2WI), and only one tumor demonstrated mixed signal on T1 and T2WI because of hemorrhage (Fig. 1 A2, A3). Two NF-1 associated tumors showed more complex signal on T2WI than other tumors (Figs. 2 B2, 3 C2). While in BPNST group, 20 (71.4 %) tumors were hypo-intense on T1WI and hyper-intense signal on T2WI, 2 (7.2 %) were mixed-intense signal, and 6 (21.4 %) were iso-intense on T1WI and hyper-intense signal on T2WI. Homogeneity of T1WI can be seen in 10 BPNSTs and 4 MPNSTs, whereas homogeneity of T2WI can only be seen in 1 BPNST. Typical target sign can be observed in five cases of BPNST but absent in all MPNST cases. Adjacent soft tissue swelled and exhibited hyper-intense signal on T2WI only in three cases of MPNST (Fig. 2 B2). On plain CT scan, density of tumors tended to be similar to that of the muscle. In a facial MPNST, calcification, hemorrhage, and adjacent bone erosion can be found (Fig. 1 A1). Enhancing pattern on CT and MR was much alike. After contrast administration, MPNST showed peripheral enhancement (Figs. 1 A4, 4 D2) (three of five MR, one CT) or irregular enhancement (Fig. 3 C3) (two of five MR). Peripheral enhancement was seen more often in MPNST than in BPNST (4 of 28).Fig. 1

Bottom Line: Location, size, shape, signal or density, boundary, bone destruction, relation to adjacent nerve, contrast-enhanced features as well as some other signs were assessed and compared with statistical software.A P value ≤0.05 was considered to be statistically significant.Peripheral enhancement with non-cystic appearance or remarkable heterogeneous enhancement may be useful for differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Imaging, Subei People's Hospital of Jiangsu Province, 98# Western Nantong Road, Yangzhou, 225001, China.

ABSTRACT

Background: Malignant peripheral nerve sheath tumor (MPNST) is a kind of rare neurogenic tumor. If associated with neurofibromatosis type 1, MPNST usually has a higher mortality. The aim of the article is to assess the imaging characteristics of MPNST and compare them with those of benign peripheral nerve sheath tumor (BPNST) to characterize this tumor.

Methods: Clinical and imaging data of six cases with MPNST and 28 cases with BPNST in our institution since 2011 were retrospectively reviewed. Thirty-three patients have available MR imaging data, and two patients of MPNST also accepted CT scan. One patient accepted CT scan only. Location, size, shape, signal or density, boundary, bone destruction, relation to adjacent nerve, contrast-enhanced features as well as some other signs were assessed and compared with statistical software. Student's t test was used for comparison of continuous variables. Fisher's exact test was used for analysis of nominal variable. A P value ≤0.05 was considered to be statistically significant.

Results: Differences existed between two groups in tumor size ((7.2 ± 3.3)cm in MPNST vs. (3.8 ± 1.4)cm in BPNST), unclear margin (4/6 in MPNST vs. 1/28 in BPNST), eccentricity to the nerve (1/6 in MPNST vs. 21/28 in BPNST), intratumoral lobulation (4/6 in MPNST vs. 2/28 in BPNST), peritumoral edema (3/6 in MPNST vs. 0 in BPNST), and peripheral enhancement (4/6 in MPNST (three of five MR, one CT) vs. 4/28 in BPNST). Bone destruction was observed in one MPNST.

Conclusions: MR imaging is a valuable, non-invasive modality for the diagnosis of MPNST. Peripheral enhancement with non-cystic appearance or remarkable heterogeneous enhancement may be useful for differential diagnosis. Other imaging features such as large size (over 5 cm in diameter), ill-defined margin, intratumoral lobulation, peritumoral edema, and adjacent bone destruction are also supportive of MPNST.

No MeSH data available.


Related in: MedlinePlus