EURORAD ESR

Case 10854

An extremely rare case of an intramuscular nuchal type fibroma in distal arm

Author(s)
M Parveen Sulthana, B Ashiq Zindha, K S Sekhar, S Saravanakumar, V Malathi

Department of Radiology and Imaging Sciences,
Billroth Hospitals, Chennai, India;
Email:dr_ashiqzindha@yahoo.co.in
 
Patient
male, 48 year(s)
 
 
  • Figure 1
    Plain radiographs of right arm and elbow
     

    A rounded soft tissue opacity along the medial aspect of the distal humerus is seen. No significant calcification is seen within this opacity. The underlying bones appear normal.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    A prominent soft tissue opacity is noted anterior to the distal right humerus on the lateral view. No significant underlying bony abnormality is noted. The elbow joint appears unremarkable.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    MRI
     

    T1W sagittal image showing a relatively well defined mass lesion with predominant hypointense signal within the brachialis muscle anterior to the distal humerus.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    T2W sagittal image also shows a predominantly hypointense mass lesion within the brachialis muscle.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    T1W coronal image shows a hypointense mass lesion within the anteromedial aspect of brachialis muscle. Few irregular hypointense areas in the subcutaneous soft tissue medial to the mass are likely related to previous...

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Coronal STIR image showing the intramuscular hypointense mass lesion within the brachialis muscle and the likely post biopsy subcutaneous soft tissue changes.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    STIR axial image shows a hypointense mass within the brachialis muscle focally abutting the anterior margin of humerus and displacing neurovascular structures anteriorly. Likely post-biopsy changes also seen in...

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 3
    Post contrast T1 Weighted fat saturated MRI
     

    Sagittal image shows heterogeneous contrast enhancement within the mass lesion.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Coronal image showing enhancement within the mass lesion and in soft tissues along the likely biopsy path. Vascular structures appear displaced around the lesion.

     
    Area of Interest: Musculoskeletal joint; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Axial image shows an enhancing mass lesion within the expanded brachialis muscle displacing neurovascular structures anteriorly and abutting anterior margin of humerus. Enhancement also seen in soft tissues along...

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 4
    Histopathology

    Histopathology revealed a poorly circumscribed unencapsulated neoplasm of low cellularity composed of spindle cells embedded in pinkish colagen bundles with scattered thin blood vessels, nerve bundles, muscle...

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Experimental; Procedure: Biopsy; Diagnostic procedure; Special Focus: Neoplasia;
     
     
A rounded soft tissue opacity along the medial aspect of the distal humerus is seen. No significant calcification is seen within this opacity. The underlying bones appear normal.
 
A prominent soft tissue opacity is noted anterior to the distal right humerus on the lateral view. No significant underlying bony abnormality is noted. The elbow joint appears unremarkable.
 
T1W sagittal image showing a relatively well defined mass lesion with predominant hypointense signal within the brachialis muscle anterior to the distal humerus.
 
T2W sagittal image also shows a predominantly hypointense mass lesion within the brachialis muscle.
 
T1W coronal image shows a hypointense mass lesion within the anteromedial aspect of brachialis muscle. Few irregular hypointense areas in the subcutaneous soft tissue medial to the mass are likely related to previous biopsy.
 
Coronal STIR image showing the intramuscular hypointense mass lesion within the brachialis muscle and the likely post biopsy subcutaneous soft tissue changes.
 
STIR axial image shows a hypointense mass within the brachialis muscle focally abutting the anterior margin of humerus and displacing neurovascular structures anteriorly. Likely post-biopsy changes also seen in medial subcutaneous soft tissues.
 
Sagittal image shows heterogeneous contrast enhancement within the mass lesion.
 
Coronal image showing enhancement within the mass lesion and in soft tissues along the likely biopsy path. Vascular structures appear displaced around the lesion.
 
Axial image shows an enhancing mass lesion within the expanded brachialis muscle displacing neurovascular structures anteriorly and abutting anterior margin of humerus. Enhancement also seen in soft tissues along likely path of previous biopsy.
 
Histopathology revealed a poorly circumscribed unencapsulated neoplasm of low cellularity composed of spindle cells embedded in pinkish colagen bundles with scattered thin blood vessels, nerve bundles, muscle fragments and adipose tissue.
 
 
 
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