Small indeterminate superficial soft tissue masses: relationship between depth and histological grade

2020 ◽  
Vol 93 (1110) ◽  
pp. 20191037
Author(s):  
Michael Khoo ◽  
Ian Pressney ◽  
Craig Gerrand ◽  
Asif Saifuddin
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Histological Grade ◽  
Definitive Treatment ◽  
Excision Biopsy ◽  
Anatomical Location ◽  
Intermediate Grade ◽  
Tissue Mass ◽  
Soft Tissue Masses ◽  
Superficial Soft Tissue

Objective: To determine whether the location of a small, indeterminate soft tissue mass within the subcutaneous compartment is related to its histological grade. Methods: All Sarcoma Service referrals over a 12 month period of small (<3 cm) superficial soft tissue masses, indeterminate by MRI evaluation which subsequently underwent primary excision biopsy were included. Lesions were categorised by their anatomical location in the subcutaneous compartment. Histopathological diagnoses were categorized according to 12 WHO 2013. χ2 statistical analysis was performed to determine the relationship between lesion depth and histological grade. Results: The study included 43 patients, mean age 42 years (range 15–71 years). Within the subcutaneous compartment, 16 lesions were categorized as superficial, 9 lesions central and 18 lesions deep, of which 9 were non-neoplastic, 29 benign, 1 intermediate-grade and 4 malignant. Location in the deep aspect of the subcutaneous compartment was associated with a higher risk of intermediate or malignant histology (p = 0.02). Conclusion: The location of a small, indeterminate soft tissue mass within the subcutaneous compartment may be an indicator of histological aggressiveness. Lesions in the deep subcutaneous compartment are more likely to be intermediate-grade/malignant lesions. Therefore, if considering excision biopsy as definitive treatment, a wider margin may be appropriate. Advances in knowledge: Small, indeterminate soft tissue masses can be aggressive and the anatomical depth within the subcutaneous tissue may be a potential indicator of histological aggressiveness.

scholarly journals Idiopathic hypertrophic pachymeningitis presenting with a superficial soft tissue mass

2012 ◽  
Vol 03 (02) ◽  
pp. 193-195 ◽  
Author(s):  
Ajantha Keshavaraj ◽  
Ranjanie Gamage ◽  
G M Jayaweera ◽  
Inuka Kishara Gooneratne
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Inflammatory Cells ◽  
Systemic Autoimmune Disease ◽  
Excision Biopsy ◽  
Temporal Region ◽  
Hypertrophic Pachymeningitis ◽  
Complex Partial Seizures ◽  
Tissue Mass ◽  
Superficial Soft Tissue

ABSTRACTIdiopathic hypertrophic pachymeningitis (IHP) is a chronic progressive diffuse inflammatory fibrosis of the duramater, leading to its diffuse enlargement. The following describes a case of IHP presenting with a superficial soft tissue mass. A 40-year-old female came to hospital with a subcutaneous lump over the left face and frontal headache for 6 months. An excision biopsy revealed chronic inflammation. Magnetic resonance imaging (MRI) of the brain showed left mastoiditis and early dural inflammation of the left temporal region. A few months later, she developed diplopia, complex partial seizures, and retrobulbar neuritis of the left optic nerve. Repeat MRI brain demonstrated meningeal thickening on both sides of the tentorium cerebelli extending to the left tempero-parietal meninges. The meningeal biopsy revealed markedly thickened fibro-connective dural tissue with infiltration of chronic inflammatory cells. There was no evidence of bacterial, fungal, tuberculous or neoplastic infiltration. IHP was diagnosed and steroid therapy initiated. Within weeks, she showed marked clinical improvement. IHP is a diagnosis of exclusion. The absence of underlying infective, neoplastic, or systemic autoimmune disease favors IHP. The above patient had headache, neuro-ophthalmic signs, seizures, which are features of IHP. However, superficial soft tissue involvement is rare.

CHARACTERISTICS OF SOFT TISSUE MASS IN THE HAND BY ULTRASONOGRAPHIC EXAMINATION

2005 ◽  
Vol 09 (01) ◽  
pp. 45-51
Author(s):  
Alexander Blankstein ◽  
Aharon Chechick ◽  
Abraham Adunski ◽  
Uri Givon ◽  
Yigal Mirovski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Wrist Joint ◽  
Imaging Modality ◽  
Routine Practice ◽  
X Rays ◽  
Diagnostic Challenge ◽  
Tissue Mass ◽  
Soft Tissue Masses ◽  
The Right

Soft tissue masses are amongst the commonest complaints encountered in orthopedic practice. Of these, masses found in the hand and the wrist are presented at higher frequency. They are often painful and may cause limitation of movement. This work describes the prevalence and the nature of soft tissue masses in the hand and wrist encountered in routine practice. This work was performed to assess the characteristics of soft tissue mass in the hand and the effectiveness of ultrasonography in the diagnosis of soft tissue masses and their differentiation from other lesions in the hand and wrist. Orthopedic surgical conditions that involve soft tissue in the hand and wrist may remain a diagnostic challenge when clinical diagnosis is uncertain and standard X-rays are non-diagnostic. High resolution ultrasound is widely available, non-invasive, without damage of radiation, imaging modality that can help the diagnosis. We reviewed retrospectively 25 patients with soft tissue masses. We compared the ultrasound findings with the histological findings in seven operated patients. A substantial majority of these lesions occurred in the right hand: 79% of the lesions were in the dorsal aspect of the hand, of which 37% were distal to the wrist joint, among them 42% at wrist either radial or ulnar; and 21% of the lesions were found in the volar aspect, among them 17% at wrist aspect, either radial or ulnar side. No predisposing factors could be found. The findings of this study reaffirm the utility of ultrasonography as primary diagnostic tool in routine orthopedic practice.

Paratesticular Soft-Tissue Masses in Orchiectomy Specimens: A 17-Year Survey of Primary and Incidental Cases From One Institution

2017 ◽  
Vol 25 (6) ◽  
pp. 480-487 ◽  
Author(s):  
David S. Priemer ◽  
Karen Trevino ◽  
Shaoxiong Chen ◽  
Thomas M. Ulbright ◽  
Muhammad T. Idrees
Keyword(s):  
Soft Tissue ◽  
Spermatic Cord ◽  
Soft Tissue Mass ◽  
Young Patients ◽  
Benign Neoplasm ◽  
Rete Testis ◽  
Benign Neoplasms ◽  
Tissue Mass ◽  
Common Diagnosis ◽  
Soft Tissue Masses

The paratestis (PT) is defined by the testicular tunics, epididymis, spermatic cord, rete testis, and embryonic remnants. It gives rise to a large diversity of pathologies, including those of soft tissue, which may prompt orchiectomy. We performed a 17-year search of our database for orchiectomies for a PT soft-tissue mass. In a total of 4741 orchiectomy specimens, 138 orchiectomies were performed for primary neoplastic or nonneoplastic masses of the PT soft tissue or had an incidental PT soft-tissue mass. Of these, 65.9% were neoplastic. The mean age was 40.2 years (range: <1 to 87 years) and was similar for neoplastic and nonneoplastic lesions. The most common malignancies were rhabdomyosarcoma (31/63 malignancies), liposarcoma (19/63), and leiomyosarcoma (5/63), with the former occurring in younger patients (average: 18.3 years). No malignancies were incidental. The most common benign neoplasm was spermatic cord lipoma (24/28 of benign neoplasms); however, most were incidental. This was followed by leiomyoma (3/28) and hemangioma (1/28). The most common nonneoplastic lesions were adrenal rests (22/47 nonneoplastic cases); however, all were incidental findings. Of 47 nonneoplastic masses, 22 prompted orchiectomy, and of these, the most common diagnosis was fibrous/nodular periorchitis (11/47). Of 88 nonincidental lesions, 25 were either benign neoplasms (3/25) or nonneoplastic (22/25). These data indicate that PT soft-tissue neoplasms prompting orchiectomy are disproportionately rhabdomyosarcomas, though these are principally in young patients. In older patients, malignancies are more frequently liposarcomas. However, almost one-third of orchiectomies performed for PT soft-tissue masses yield benign lesions, indicating an opportunity to reduce unnecessary procedures.

scholarly journals Giant epidermal cyst of the foot

2014 ◽  
Vol 142 (9-10) ◽  
pp. 607-609 ◽  
Author(s):  
Melih Malkoc ◽  
Özgür Korkmaz ◽  
Yıldıray Genç ◽  
Ferhat Say ◽  
Mahmut Aytekin
Keyword(s):  
Soft Tissue ◽  
Epidermoid Cyst ◽  
Soft Tissue Mass ◽  
Surgical Excision ◽  
Epidermal Cyst ◽  
Pathology Report ◽  
X Rays ◽  
Tissue Mass ◽  
Palpable Mass ◽  
Soft Tissue Masses

Introduction. Epidermoid inclusion cysts are usually composed of epidermal elements implanted into the dermal layers. Patients are seen in the outpatient clinics with a mass. Most of the complaints are mechanical and cosmetic problems. Case Outline. A 34-year-old female patient was admitted to our clinic because of swelling and pain in her right foot. A palpable mass was detected in the first web. On the x-rays of the foot no osseous lesion was detected. There was a soft tissue mass in the first web according to MRI report. Soft tissue mass was excised and sent to pathology. According to pathology report the mass was an epidermoid cyst 5?2?1.5 cm in size. There were no problems during follow-up of the patient for 6 months after surgery. The patient had no swelling in the foot and had no additional complaints on checkup. Conclusion. In the differential diagnosis, we should take into consideration epidermoid cyst of large soft tissue masses of the foot. Surgical excision should be done within the appropriate limits.

ALK-Negative Anaplastic Large Cell Lymphoma Presenting as an Extranodal Soft-Tissue Mass With an Unusual Alveolar Growth Pattern: A Diagnostic Challenge

2017 ◽  
Vol 25 (6) ◽  
pp. 502-506
Author(s):  
Badr AbdullGaffar ◽  
Rania M. Seliem
Keyword(s):  
Soft Tissue ◽  
Anaplastic Large Cell Lymphoma ◽  
Growth Pattern ◽  
Cell Lymphoma ◽  
Soft Tissue Mass ◽  
Large Cell ◽  
Neoplastic Cells ◽  
Tissue Mass ◽  
Soft Tissue Masses ◽  
Large Cell Lymphoma

Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma which has been recognized to have a variable clinical presentation and a broad spectrum of histomorphologic features. Its variable histomorphologic appearances are sometimes diagnostically challenging for the pathologists since they can mimic sarcomas, melanomas and undifferentiated carcinomas. To our knowledge, a previous case of axillary soft-tissue mass of ALK-positive ALCL with an alveolar growth pattern has been so far reported in the literature. This alveolar appearance is unusual for ALCL. It can impose a diagnostic pitfall, particularly in extranodal soft-tissue masses. We report a case of ALK-negative ALCL that presented as an extranodal soft-tissue neck mass in an adult man. Histologically, it showed a characteristic alveolar growth pattern composed of well-defined nests of dyscohesive highly pleomorphic large neoplastic cells separated by thin fibrovascular septae. Morphologically, it mimicked sarcomas, carcinomas, melanoma and germ cell neoplasms. Initially, a histologic diagnosis of ALCL was not considered. However, the negative immunomarkers for the above mimickers and the strong CD30 positivity have raised the suspicion of anaplastic lymphomas. Further immunohistochemistry studies showed the neoplastic cells to be positive for CD4 and CD43. This case report emphasizes the potential diagnostic pitfalls associated with an ALK-negative ALCL when manifests as a soft-tissue mass with an alveolar growth pattern. Pathologists should be aware of this uncommon growth pattern in ALCLs. They should implement a broad panel of immunomarkers in soft-tissue masses of anaplastic pleomorphic cells with an alveolar morphology.

Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery

2010 ◽  
Vol 5 (1) ◽  
pp. 136-139 ◽  
Author(s):  
Masabumi Miyamoto ◽  
Ryu Tsunoda ◽  
Yoshikazu Gembun ◽  
Shunsuke Konno ◽  
Yusuke Hagiwara ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Tissue Mass ◽  
Histopathological Findings ◽  
Primary Surgery ◽  
Recurrent Case ◽  
Fibrous Hamartoma Of Infancy ◽  
Superficial Soft Tissue

Fibrous hamartoma of infancy is a rare, benign, superficial soft-tissue mass. It usually occurs within the first 2 years of life at the axial regions, upper arms, and external genital areas. There have been some recurrences within the 1st year of the surgery, although no cases have been reported to recur after 1 year. The authors present a recurrent case of fibrous hamartoma of infancy 14 years after the primary surgery, and they show the clinical and histopathological findings.

scholarly journals Lipoblastomas and liposarcomas in paediatric patients: A case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052098136
Author(s):  
Joyce J.L.H McRae ◽  
Asra Hashmi ◽  
Andrei Radulescu ◽  
Cody S. Carter ◽  
Faraz A. Khan
Keyword(s):  
Soft Tissue ◽  
Histological Examination ◽  
Clinical Case ◽  
Soft Tissue Mass ◽  
Case Series ◽  
Surgical Excision ◽  
Tissue Mass ◽  
Paediatric Patients ◽  
Soft Tissue Masses

Lipoblastomas and liposarcomas are rare causes of soft tissue masses in paediatric patients. In this retrospective clinical case series we identified 11 patients from our paediatric database (10 with a lipoblastoma and one with a liposarcoma) who had attended our hospital between 1998 and 2019. The median age of patients with lipoblastoma was 29 months. All lipoblastoma cases were managed with surgical excision and histological examination. The 18-year old patient with liposarcoma presented with a metastatic and unresectable tumour that was unresponsive to chemotherapy and radiation. Our experience demonstrates the importance of differentiating the type of soft tissue mass in children.

Predictors of Neurovascular Displacement in Hands with Dupuytren’s Contracture

1994 ◽  
Vol 19 (5) ◽  
pp. 664-666 ◽  
Author(s):  
M. E. UMLAS ◽  
R. J. BISCHOFF ◽  
R. H. GELBERMAN
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Tissue Mass ◽  
Joint Contractures ◽  
Dupuytren's Contracture ◽  
Pip Joint ◽  
Soft Tissue Masses ◽  
A Prospective Study

A prospective study of hands with Dupuytren’s contracture was designed to test the association of three variables, the presence of an interdigital soft tissue mass, the presence of flexion contractures at each digital joint, and the duration of contracture, with the formation of spiral nerves. 66 digits in 37 hands affected by Dupuytren’s disease were examined intra-operatively. Of the 34 digits (52%) with spiral nerves, 28 had soft tissue masses (42%). The sensitivity of a soft tissue mass alone as a predictor of a spiral nerve was 59% and the specificity 75%. The presence of a flexion contracture at the PIP joint had a sensitivity of 88% and a specificity of 62% for the presence of a spiral nerve. The combination of a soft tissue mass and a PIP joint contracture was a very specific (94%) but not a particularly sensitive (50%) test for spiral nerve formation. The formation of a spiral nerve is progressive, occurring most often in hands with significant PIP joint contractures with or without soft tissue interdigital masses.

Malignant Soft Tissue Masses

2019 ◽  
pp. 346-350
Author(s):  
Kevin J. Blount
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Imaging Modality ◽  
Diagnostic Delay ◽  
Soft Tissue Tumors ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Tissue Mass ◽  
Soft Tissue Masses ◽  
Malignant Soft Tissue

Chapter 66 discusses malignant soft tissue masses. Soft tissue malignancies are less common than those of benign origin but should be in the differential diagnosis for any soft tissue mass. Malignant soft tissue tumors have a wide range of clinical and imaging appearances, which can present a diagnostic challenge. If the imaging features of the soft tissue mass are not entirely characteristic for a benign diagnosis, biopsy should be performed. After initial radiographs, MRI is considered the best imaging modality to characterize malignant soft tissue lesions. Prompt diagnosis is critical because a diagnostic delay is associated with a worse clinical outcome.

Fibro-Osseous Pseudotumor of the Hand

2016 ◽  
Vol 21 (02) ◽  
pp. 269-272 ◽  
Author(s):  
Vasileios A. Kontogeorgakos ◽  
Dionysios J. Papachristou ◽  
Sokratis Varitimidis
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Mass ◽  
Dorsal Surface ◽  
Tissue Mass ◽  
Peripheral Ring ◽  
High Grade Sarcoma ◽  
Soft Tissue Masses ◽  
Web Space ◽  
Ring Core

Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and imaging findings may resemble high-grade sarcoma or infection. We describe a patient with progressive pain and swelling at the dorsal surface of the first web space. MRI and CT imaging revealed an intramuscular heterogenous soft tissue mass defined by a mineralized peripheral ring. Core needle biopsy diagnosed FOPD. Eight months later a matured ossified nodule that was quite smaller than the initial soft tissue mass was excised. The patient is symptom free without local recurrence at 1 year follow up. Soft tissue masses of the hand pose a challenging diagnostic and therapeutic issue. An in depth interpretation of clinical, imaging and histology findings is important to avoid erroneous diagnosis and treatment.

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