A really strange one

Hi,

I’m very worried about this lesion! Age and image aspects should raise the possibility of sarcoma. In this region a Dermartofibrosarcoma Protuberans is a good call!

Best

Enviado do meu iPhone

Em 21 de set. de 2021, à(s) 16:36, ‘Sonin Andrew’ via OCAD MSK <ocad-msk@googlegroups.com> escreveu:


Would appreciate any helpful thoughts on this one. Basically 2 dissimilar masses in the anterior leg of a retired 69 year old radiologist that don’t fit my acceptable pattern for “it’s just a hematoma”……

Please, as usual, direct all responses and thoughts to me, and I will compile and report back to OCAD

thanks

Andy Sonin

so preliminary responses I have received on this strange case are (in no particular order):**I’ve reattached the case in case somebody didn’t get it the first time**

Hematoma

Dermatofibrosarcoma protuberans (my personal best guess)

“I don’t like it, needs to be biopsied” (this one got the most votes!)

Myxofibrosarcoma (at least 3 votes)

Synovial sarcoma

Morel-Lavallee lesions

Pseudoaneurysm

Nodular fasciitis
Leiomyosarcoma
and then I received this from (my hero) Mark Murphey:
“Without the history, I would have thought about DFSP with likely high grade component (Fibrosarcomatous transformation). These can have satellite nodules so that would account for multiplicity of lesions. Rapid growth is unusual but has been reported with pregnancy. Doubt he is pregnant but any anabolic steroid use? Does not look like hematoma but solid enhancing masses. Hard to think about infection or reaction to foreign body with this appearance. Myxofibrosarcoma also possible as it can be multifocal and spread along fascia but the larger lesion does not look particularly myxoid. Other weird things like nodular fasciitis, Rosai Dorfman and granuloma annulare went through my mind but not the greatest look.   Nodular fasciitis is an intriguing idea as it is subQ, could be multifocal with varying signal intensity, has been associated with trauma and can have associated edema. It can also grow rapidly at least initially. The more protuberant lesion is unusual for that diagnosis though and more common on volar side and forearm of younger women. It is also self limited at least ultimately.”
In any case, it’ll go to biopsy and I’ll report back.  FWIW, I told the patient and referring orthopod that it’s almost certainly a sarcoma of some kind, possibly DFSP, and that I would poll the OCAD to see if any other bright ideas popped up.  But it’s academic since we’ll get tissue……
thanks all for your time and consideration!
Andy Sonin

Would appreciate any helpful thoughts on this one.  Basically 2 dissimilar masses in the anterior leg of a retired 69 year old radiologist that don’t fit my acceptable pattern for “it’s just a hematoma”……
Please, as usual, direct all responses and thoughts to me, and I will compile and report back to OCAD
thanks
Andy Sonin

69M-retired-radiologist.pptx