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Acral Myxoinflammatory Fibroblastic Sarcomas: MRI Findings in Four Cases

¹ Department of Radiology, Duke University Medical Center, Durham, NC.
² Present address: Department of Radiology, Hospital Universitari de Bellvitge-IDIBELL, Feixa Llarga s/n, Hospitalet De Llobregat, Barcelona, Spain 08907.
³ Department of Pathology, Duke University Medical Center, Durham, NC.
⁴ Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —44-year-old woman with painless mass in left hand of 3 years' duration. Coronal T1-weighted MR image (TR/TE, 400/12) shows ovoid mass on fourth interdigital space that was slightly hypointense to skeletal muscle. Note complete peripheral isointense rim.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —44-year-old woman with painless mass in left hand of 3 years' duration. Coronal fast spin-echo fat-suppressed T2-weighted axial MR image (TR/TEeff, 6,200/60) shows mass to have homogeneous high signal intensity.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —44-year-old woman with painless mass in left hand of 3 years' duration. Coronal contrast-enhanced fat-suppressed T1-weighted MR image (TR/TE, 440/12) shows strong enhancement of most of lesion, with peripheral rim of decreased enhancement.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —49-year-old man with mass in right hand that is painful and tender to palpation. Axial T1-weighted MR image (TR/TE, 550/14) shows small lesion (arrows) of low signal intensity.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —49-year-old man with mass in right hand that is painful and tender to palpation. Axial fast spin-echo fat-suppressed T2-weighted MR image (TR/TEeff, 3,600/90) shows mass (arrows) of uniform high signal intensity.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —49-year-old man with mass in right hand that is painful and tender to palpation. Axial contrast-enhanced T1-weighted MR image (TR/TE, 550/14) shows homogeneous enhancement of lesion (arrows).

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —66-year-old man with painless mass in right middle finger. Anteroposterior radiograph of middle finger shows soft-tissue mass with subtle bone erosion (arrow) of proximal phalanx.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —66-year-old man with painless mass in right middle finger. Axial T1-weighted MR image (TR/TE, 550/10) shows lobulated mass on volar aspect of middle finger. Signal intensity of mass is intermediate and hypointense to skeletal muscle. Note adjacent bone infiltration (arrow) and relationship of mass to tendon.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —66-year-old man with painless mass in right middle finger. Axial fast spin-echo fat-suppressed T2-weighted MR image (TR/TEeff, 3,600/90) shows heterogeneous signal intensity of mass, with predominant areas of high signal intensity interspersed with zones of intermediate and low signal intensity. Note minimal increase of signal in adjacent phalanx.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —66-year-old man with painless mass in right middle finger. Coronal contrast-enhanced fat-suppressed T1-weighted MR image (TR/TE, 650/10) shows marked, mildly heterogeneous enhancement.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —66-year-old man with painless mass in right middle finger. Photomicrographs of specimen show alternating fibrous (E) and myxoid (F) regions of neoplasm, both with modest infiltrate of inflammatory cells. (H and E, x100)

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —66-year-old man with painless mass in right middle finger. Photomicrographs of specimen show alternating fibrous (E) and myxoid (F) regions of neoplasm, both with modest infiltrate of inflammatory cells. (H and E, x100)

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3G —66-year-old man with painless mass in right middle finger. High-power photomicrograph of specimen shows mixture of acute inflammatory cells and larger cells with vesicular nuclei. Note multinucleate giant cell in background myxoid substance. (H and E, x200)

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