CASE OF THE WEEK

A 50 yr male ,
Presented with c/o swelling in thigh
for 6months and pain for 15 days

No H/O recent trauma

No H/O fever
No H/o any other swellings

No significant past/ family history.

Examination

• Swelling of size 4 X 3 cm in anteromedial aspect of thigh

-mobile
-firm in consistency
-mild Tenderness+
-Not transluminant

- Provisional clinical diagnosis: Lipoma

Xray (lateral)
USG
 USG REPORT

• A relatively well defined Heterogenously hypoechoic lesion measuring 3.6 X

4 cm noted in the anteromedial aspect of right thigh in the subcutaneous
plane with significant surrounding fat stranding anterior to the muscular
plane

• Diagnosis was given as : Infected sebaceous cyst/ Infected epidermoid cyst.

CT
AXIAL
 CORONAL
SAGITTAL
MRI
T1 AXIAL
T2 AXIAL
STIR AXIAL
T1 CORONAL
T1 CORONAL
T2 SAGITTAL
STIR CORONAL
DIFFUSION
HPE
FINAL DIAGNOSIS

• Atypical spindle cell tumor

The radiological report should include a description of the following:

• location and size,shape

• Extension beyond compartment
• Tumor margins and transition zone,peritumoral edema
• Relations to the muscular fascia
• Relation to neurovascular structures and underlying bone
• Contrast enhancement-cystic/solid,tissue plane,vascularity
WHO CLASSIFICATION OF SOFT TISSUE TUMORS:

• Adipocytic tumors
• Fibroblastic/myofibroblastic tumors
• Vascular tumors
• Pericytic (perivascular) tumors
• Smooth muscle tumors
• Skeletal-muscle tumors
• Gastrointestinal stromal tumors
• Peripheral nerve sheath tumors
• Tumors of uncertain differentiation
 • By systematically using clinical history, lesion location, mineralization on
radiographs, and signal intensity characteristics on magnetic resonance images,
• If a lesion cannot be characterized as a benign entity, the lesion should be
reported as indeterminate, and the patient should undergo biopsy to exclude
malignancy
 Atypical spindle cell /pleomorphic lipomatous tumors
- Benign adipocytic soft tissue neoplasms with a variable proportion of atypical
spindle cells, pleomorphic cells adipocytes and other cells

• Lesion mostly seen in patients above the age of 30 years with a peak incidence in
the sixth decade
• Men are slightly more frequently affected than women
• Typical presentation is a slow-growing nodule or mass possibly associated with
tenderness
• Atypical spindle cell/pleomorphic lipomatous tumors are usually found in the
subcutaneous and deep soft tissues of the limbs and limb-girdle areas
RADIOGRAPHIC FEATURES

• Radiological features -very scarce.

• The tumors will have an unspecific lobular or multilobular appearance with a
possibly visible ill-defined fibrous capsule.
 MRI :
• Due to its variable amount of different cells, the appearance is also variable
and quite heterogeneous.

 Diagnosis
• The diagnosis of atypical spindle cell/pleomorphic lipomatous tumors is based
on typical histological and molecular pathological features
DIFFERENTIAL DIAGNOSIS

• lipoma
• well-differentiated liposarcoma
• Dedifferentiated liposarcoma
• Dermatofibrosarcoma protuberans
• Malignant peripheral nerve sheath tumor
THANK YOU