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Aggressive Fibromatosis: MRI Features with Pathologic Correlation

¹ Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Rd., London SW10 9NH, England.
² Department of Surgery, Royal Marsden Hospital, London SW3 6JJ, England.
³ Department of Pathology, Royal Marsden Hospital, London SW3 6JJ, England.
⁴ Department of Radiology, Royal Marsden Hospital, London SW3 6JJ, England.

View larger version (120K): [in a new window]   Fig. 1A —30-year-old woman who presented postpartum with abdominal mass. Axial T2-weighted MR image. Note ovoid shape and heterogeneous high T2 signal intensity of mass (arrowheads) in left rectus abdominis muscle. This is the classic site and appearance of abdominal wall fibromatosis, or desmoid tumor.

View larger version (129K): [in a new window]   Fig. 1B —30-year-old woman who presented postpartum with abdominal mass. Axial T1-weighted MR image obtained after injection of IV gadolinium shows avid contrast enhancement within center of this mass (arrows).

View larger version (148K): [in a new window]   Fig. 1B —30-year-old woman who presented postpartum with abdominal mass. Sagittal T2-weighted MR image illustrates relationship of desmoid tumor (asterisk) to left rectus abdominis muscle (arrowheads).

View larger version (153K): [in a new window]   Fig. 2 —28-year-old woman who presented with painful lump in upper arm. Axial T1-weighted MR image obtained after injection of IV gadolinium shows mass in left deltoid muscle. Bone marrow and periosteal signal are normal. Note infiltrative pattern of spread into subcutaneous tissues (black arrows) and tumor crossing fascial boundaries into flexor (arrowhead) and extensor (white arrow) compartments of arm. This is typical pattern in aggressive fibromatosis. In this case, extensive local spread deemed this lesion to be inoperable and patient was treated with adjuvant therapy only. Lesion has been stable for 36 months.

View larger version (135K): [in a new window]   Fig. 3A —23-year-old woman who presented with multicentric fibromatosis since childhood. Axial (A) and coronal (B) T2-weighted MR images through trunk show large, lobulated, mixed-signal-intensity mass (arrows, A) arising within erector spinae muscles affecting both sides of midline. Note extensive area of low signal (asterisks), typical of aggressive fibromatosis.

View larger version (160K): [in a new window]   Fig. 3B —23-year-old woman who presented with multicentric fibromatosis since childhood. Axial (A) and coronal (B) T2-weighted MR images through trunk show large, lobulated, mixed-signal-intensity mass (arrows, A) arising within erector spinae muscles affecting both sides of midline. Note extensive area of low signal (asterisks), typical of aggressive fibromatosis.

View larger version (123K): [in a new window]   Fig. 4A —24-year-old man with Gardner's syndrome who presented with abdominal pain. Axial contrast-enhanced CT image of abdomen shows amorphous soft-tissue mass (arrowheads) in mesentery. Note presence of stent (arrow) in pelvis of right kidney. Fibromatosis extended inferiorly into pelvis obstructing right ureter.

View larger version (131K): [in a new window]   Fig. 4B —24-year-old man with Gardner's syndrome who presented with abdominal pain. Axial T2-weighted MR image through abdomen shows mixed-signal-intensity mass (arrowheads) with prominent areas of low signal (arrows), believed to represent fibrosis. Percutaneous biopsy confirmed diagnosis of intraabdominal fibromatosis.

View larger version (125K): [in a new window]   Fig. 5A —52-year-old man who presented with abdominal mass. Axial contrast-enhanced CT image of abdomen shows uniformly dense soft-tissue mass (arrows) in small-bowel mesentery.

View larger version (143K): [in a new window]   Fig. 5B —52-year-old man who presented with abdominal mass. Axial unenhanced T1-weighted MR image through abdomen shows large mostly homogeneous, well-defined, ovoid mass lesion in peritoneal cavity (arrows). Mass was fully resected confirming diagnosis as intraabdominal fibromatosis. No recurrence was seen after 2 years of follow-up.

View larger version (112K): [in a new window]   Fig. 6A —60-year-old man who presented with incidental finding on conventional radiography. Conventional radiograph shows clearly marginated right apical soft-tissue noncalcified mass (arrowheads) that has appearance of Pancoast's tumor.

View larger version (141K): [in a new window]   Fig. 6B —60-year-old man who presented with incidental finding on conventional radiography. Contrast-enhanced T1-weighted coronal MR image shows enhancing mass (arrowheads) in right apex. Despite mimicking Pancoast's tumor, repeated biopsies confirmed diagnosis as fibromatosis.

View larger version (198K): [in a new window]   Fig. 7 —31-year-old man who presented with mass in thigh. Photomicrograph of H and E-stained histopathology slide shows typical features of fibromatosis. Note bland sheets of spindle cells in dense collagen stroma. Slitlike vessel is seen with minor perivascular edema and chronic inflammatory cells including lymphocytes and mast cells. Note also absence of mitoses or nuclear atypia. This appearance is seen in both primary and recurrent cases.

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