EURORAD ESR

Case 15250

Agressive fibromatosis in the popliteal fossa

Author(s)
Juan Manuel Pazos Guarín, Luis García Ferrer, María Vega Martínez, Magdalena Graells Ferrer.

Universitario Doctor Peset; Avenida Gaspar Aguilar 90 46017 Valencia, Spain; Email:Pazos0414@hotmail.com
 
Patient
female, 34 year(s)
 
 
  • Figure 1
    Ultrasound
     

    Transverse left popliteal fossa sonogram demonstrates a solid and predominantly hypoechoic mass with a macrolobulated shape and a well-circumscribed margin.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Neoplasia;

    On sagittal ultrasound the mass is fusiform in morphology.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Neoplasia;

    Colour Doppler sonogram shows mass with absent flow.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 2
    Axial and Sagittal T1-weighted MR image
     

    There is a low-signal-intensity and nodular mass arising within popliteal fascia.

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

    On sagittal plane the mass has lobulated fusiform morphology.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 3
    Sagittal fat-suppressed T2-weighted MR image and SPIR
     

    This mass shows heterogeneous signal intensity, with high signal areas interspersed with with low-signal-intensity bands (arrow). Low signal intensity popliteal fascia thickening that involves the proximal portion...

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

    Spectral Attenuated Inversion Recovery (SPIR) MR image. The high signal intensity on the T2-weighted image and SPIR corresponded to a more cellular lesion with less collagen (red arrow).

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 4
    Axial T1-weighted image after contrast administration
     

    There is a nodular, irregular lesion, in the popliteal recess of knee joint, with enhancement predominantly peripheral in location.

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

    Superiorly the mass extending in the depth of the popliteal fossa and contacting with the common fibular nerve (red circle).

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 5
    Subtraction axial MR image
     

    There is avid contrast-enhancement predominantly within peripheral of the lesion.

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

    Subtraction image confirms the presence of an enhancing within this mass.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 6
    Dynamic contrast-enhanced magnetic resonance imaging
     

    Orange circular ROI over the artery. Green ROI over the lesion.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Education; Special Focus: Neoplasia;

    It shows a type 2 pattern, with slow initial rise followed by a plateau in the delayed phase without early washout as a predictor of benign lesion histology.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 7
    Axial diffusion-weighted image
     

    The mass showed mild restricted difussion probably corresponding to varying proportions of cellular tissue.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Education; Special Focus: Neoplasia;

    Low signal intensity on ADC map. The mass showed mild restricted diffusion.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Education; Special Focus: Neoplasia;
     
     
Transverse left popliteal fossa sonogram demonstrates a solid and predominantly hypoechoic mass with a macrolobulated shape and a well-circumscribed margin.
 
On sagittal ultrasound the mass is fusiform in morphology.
 
Colour Doppler sonogram shows mass with absent flow.
 
There is a low-signal-intensity and nodular mass arising within popliteal fascia.
 
On sagittal plane the mass has lobulated fusiform morphology.
 
This mass shows heterogeneous signal intensity, with high signal areas interspersed with with low-signal-intensity bands (arrow). Low signal intensity popliteal fascia thickening that involves the proximal portion (this reflects the amount of collagen within tumour).
 
Spectral Attenuated Inversion Recovery (SPIR) MR image. The high signal intensity on the T2-weighted image and SPIR corresponded to a more cellular lesion with less collagen (red arrow).
 
There is a nodular, irregular lesion, in the popliteal recess of knee joint, with enhancement predominantly peripheral in location.
 
Superiorly the mass extending in the depth of the popliteal fossa and contacting with the common fibular nerve (red circle).
 
There is avid contrast-enhancement predominantly within peripheral of the lesion.
 
Subtraction image confirms the presence of an enhancing within this mass.
 
Orange circular ROI over the artery. Green ROI over the lesion.
 
It shows a type 2 pattern, with slow initial rise followed by a plateau in the delayed phase without early washout as a predictor of benign lesion histology.
 
The mass showed mild restricted difussion probably corresponding to varying proportions of cellular tissue.
 
Low signal intensity on ADC map. The mass showed mild restricted diffusion.
 
 
 
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