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Sclerosing liposarcoma of epididymis: Role of chemical shift magnetic resonance imaging

View Article: PubMed Central - PubMed

ABSTRACT

Sclerosing liposarcoma of epididymis is a rare extratesticular scrotal tumor with variable prognosis. Ultrasonography is the initial imaging modality of choice for the evaluation of scrotal mass and helps to differentiate testicular and extratesticular masses, thereby narrowing down the differential diagnosis. Magnetic resonance imaging with its excellent soft tissue resolution can help in the further characterization of the nature of the tumor. In this case report, we highlight the role of chemical shift imaging in making a confident preoperative diagnosis of liposarcoma thereby guiding optimal and timely management.

No MeSH data available.


Related in: MedlinePlus

(A) Axial T2-weighted MRI shows heterogeneous hyperintense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (B) Axial T1-weighted MRI shows heterogeneous isointense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (C) Sagittal T2-weighted MRI shows clearly the posteroinferior location of the mass (arrow) in relation to the left testis (asterisk) suggesting possible epididymal origin
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Figure 2: (A) Axial T2-weighted MRI shows heterogeneous hyperintense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (B) Axial T1-weighted MRI shows heterogeneous isointense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (C) Sagittal T2-weighted MRI shows clearly the posteroinferior location of the mass (arrow) in relation to the left testis (asterisk) suggesting possible epididymal origin

Mentions: MRI scrotum was performed using 1.5-T system (Magnetom Avanto, Siemens Healthcare, Malvern, Pennsylvania, USA) using a circular surface coil. Scrotal MRI protocol included axial T1-weighted (T1W) turbo spin echo (TSE) with and without fat suppression, three plane T2W TSE, axial fat-suppressed T2W TSE, and two-dimensional T1W dual echo in and opposed phase chemical shift imaging (CSI). Patients received 0.1 mmol/kg of body weight of gadopentetate dimeglumine (Magnevist, Bayer HealthCare Pharmaceuticals, Whippany NJ, USA) approximately 1 min prior to axial and coronary fat-suppressed T1W postcontrast TSE images. MRI showed a heterogenous T2 hyperintense and T1 isointense mass in the left hemiscrotum posteroinferior to and separate from the left testis displacing it more superiorly [Figure 2]. Differential diagnosis of adenomatoid tumor, fibrous pseudotumor, and low grade sarcoma probably of epididymal origin were considered considering its posteroinferior location. CSI (in and opposed phase images) is a special sequence performed to detect microscopic fat and is routinely performed in all abdomen and pelvic MRI in our institution. It was also performed in this patient and revealed signal drop on the opposed phase indicating the presence of fat within the tumor, favoring the diagnosis of lipid containing benign or malignant tumors [Figure 3]. It showed heterogenous enhancement on postcontrast images [Figure 3].


Sclerosing liposarcoma of epididymis: Role of chemical shift magnetic resonance imaging
(A) Axial T2-weighted MRI shows heterogeneous hyperintense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (B) Axial T1-weighted MRI shows heterogeneous isointense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (C) Sagittal T2-weighted MRI shows clearly the posteroinferior location of the mass (arrow) in relation to the left testis (asterisk) suggesting possible epididymal origin
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036334&req=5

Figure 2: (A) Axial T2-weighted MRI shows heterogeneous hyperintense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (B) Axial T1-weighted MRI shows heterogeneous isointense mass (arrow) in the left hemiscrotum separate from the testis (asterisk). (C) Sagittal T2-weighted MRI shows clearly the posteroinferior location of the mass (arrow) in relation to the left testis (asterisk) suggesting possible epididymal origin
Mentions: MRI scrotum was performed using 1.5-T system (Magnetom Avanto, Siemens Healthcare, Malvern, Pennsylvania, USA) using a circular surface coil. Scrotal MRI protocol included axial T1-weighted (T1W) turbo spin echo (TSE) with and without fat suppression, three plane T2W TSE, axial fat-suppressed T2W TSE, and two-dimensional T1W dual echo in and opposed phase chemical shift imaging (CSI). Patients received 0.1 mmol/kg of body weight of gadopentetate dimeglumine (Magnevist, Bayer HealthCare Pharmaceuticals, Whippany NJ, USA) approximately 1 min prior to axial and coronary fat-suppressed T1W postcontrast TSE images. MRI showed a heterogenous T2 hyperintense and T1 isointense mass in the left hemiscrotum posteroinferior to and separate from the left testis displacing it more superiorly [Figure 2]. Differential diagnosis of adenomatoid tumor, fibrous pseudotumor, and low grade sarcoma probably of epididymal origin were considered considering its posteroinferior location. CSI (in and opposed phase images) is a special sequence performed to detect microscopic fat and is routinely performed in all abdomen and pelvic MRI in our institution. It was also performed in this patient and revealed signal drop on the opposed phase indicating the presence of fat within the tumor, favoring the diagnosis of lipid containing benign or malignant tumors [Figure 3]. It showed heterogenous enhancement on postcontrast images [Figure 3].

View Article: PubMed Central - PubMed

ABSTRACT

Sclerosing liposarcoma of epididymis is a rare extratesticular scrotal tumor with variable prognosis. Ultrasonography is the initial imaging modality of choice for the evaluation of scrotal mass and helps to differentiate testicular and extratesticular masses, thereby narrowing down the differential diagnosis. Magnetic resonance imaging with its excellent soft tissue resolution can help in the further characterization of the nature of the tumor. In this case report, we highlight the role of chemical shift imaging in making a confident preoperative diagnosis of liposarcoma thereby guiding optimal and timely management.

No MeSH data available.


Related in: MedlinePlus