EURORAD ESR

Case 14912

False pelvic lymphadenopathy on oncologic patient. Low-grade malignant sheath tumor of sciatic nerve.

Author(s)
PESQUERA MUÑOZ A.S., CERVERA MIGUEL J.I., NERSESYAN N., SANCHÍS GARCÍA J.M., GIL VIANA R., CAMPOS HERVÁS S., POMARES POMARES J.J.

Hospital Clínico Universitario de Valencia, Department of Radiology; Avenida Blasco Ibañez 17

46010 Valencia, Spain;
Email:aspm.sasao@gmail.com
 
Patient
male, 74 year(s)
 
 
  • Figure 1
    Figure 1. Oncologic CT control.

    Axial abdominal and pelvic enhanced CT: Left pelvic mass with central areas with no enhancement. Necrotic adenopathy was suspected in the first place. However, it can be identified its tapered lateral ending.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 2
    Figure 2. Pelvic MRI sequences.
     

    Axial T1-WI: Left pelvic well defined mass with tapered lateral end is identified. It reaches 53 mm. The lesion has low signal, isointense to adjacent piriform muscle.

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

    Axial T2-WI: Left pelvic well defined mass with tapered lateral end is identified. It reaches 53 mm. Note the markedly hyperintense central cystic areas.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Cysts;

    Sagittal T2-WI: Cranial extreme of the lesion arises from ipsilateral sciatic nerve.

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

    Coronal T2-WI: Cranial extreme of the lesion arises from ipsilateral sciatic nerve.

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

    Axial T1-WI FAT SAT enhanced with intravenous Gadolinium: Markedly contrast uptake on the lesion is observed. Nevertheless, there is no enhancement on the central cystic areas, probably related with necrosis.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 3
    Figure 3. Biopsy CT-guided

    Axial CT non-enhanced with patient in prone position. 18 G needle is identified crossing the ipsilateral gluteus maximus and piriformis muscles to obtain 1 lesion cylinder

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;
     
     
Axial abdominal and pelvic enhanced CT: Left pelvic mass with central areas with no enhancement. Necrotic adenopathy was suspected in the first place. However, it can be identified its tapered lateral ending.
 
Axial T1-WI: Left pelvic well defined mass with tapered lateral end is identified. It reaches 53 mm. The lesion has low signal, isointense to adjacent piriform muscle.
 
Axial T2-WI: Left pelvic well defined mass with tapered lateral end is identified. It reaches 53 mm. Note the markedly hyperintense central cystic areas.
 
Sagittal T2-WI: Cranial extreme of the lesion arises from ipsilateral sciatic nerve.
 
Coronal T2-WI: Cranial extreme of the lesion arises from ipsilateral sciatic nerve.
 
Axial T1-WI FAT SAT enhanced with intravenous Gadolinium: Markedly contrast uptake on the lesion is observed. Nevertheless, there is no enhancement on the central cystic areas, probably related with necrosis.
 
Axial CT non-enhanced with patient in prone position. 18 G needle is identified crossing the ipsilateral gluteus maximus and piriformis muscles to obtain 1 lesion cylinder
 
 
 
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