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Myxoid Liposarcoma: Appearance at MR Imaging with Histologic Correlation¹

¹ From the Department of Radiology, Catholic University of Korea at Holy Family Hospital, Sosa-dong, Puchun, Kyunggido 420-717, Korea (M.S.S., J.M.P., J.Y.K., H.G.L.); the Department of Radiology, Seoul National University Hospital, Seoul, Korea (H.S.K.); the Department of Radiology, Yonsei University, Shinchon Severance Hospital, Seoul (J.S.S.); and the Department of Radiology, Korea Cancer Center, Seoul (J.H.L.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received April 8, 1999; revision requested May 6 and received July 2; accepted July 7. Address correspondence to M.S.S. (e-mail: mssung@clin.hfh.cuk.ac.kr).

View larger version (139K): [in a new window]   Figure 1a.   Myxoid liposarcoma with a typical appearance and homogeneous enhancement. (a) Sagittal T1-weighted MR image shows linear high-signal-intensity foci of fat within a predominantly low-signal-intensity mass. (b) Sagittal T2-weighted MR image shows foci of intermediate signal intensity within the high-signal-intensity mass. (c) Contrast material-enhanced sagittal T1-weighted MR image shows marked homogeneous enhancement throughout the mass. (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of the pathologic specimen shows a prominent plexiform capillary pattern, cellularity, an abundance of myxoid material, and lipoblasts.

View larger version (123K): [in a new window]   Figure 1b.   Myxoid liposarcoma with a typical appearance and homogeneous enhancement. (a) Sagittal T1-weighted MR image shows linear high-signal-intensity foci of fat within a predominantly low-signal-intensity mass. (b) Sagittal T2-weighted MR image shows foci of intermediate signal intensity within the high-signal-intensity mass. (c) Contrast material-enhanced sagittal T1-weighted MR image shows marked homogeneous enhancement throughout the mass. (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of the pathologic specimen shows a prominent plexiform capillary pattern, cellularity, an abundance of myxoid material, and lipoblasts.

View larger version (121K): [in a new window]   Figure 1c.   Myxoid liposarcoma with a typical appearance and homogeneous enhancement. (a) Sagittal T1-weighted MR image shows linear high-signal-intensity foci of fat within a predominantly low-signal-intensity mass. (b) Sagittal T2-weighted MR image shows foci of intermediate signal intensity within the high-signal-intensity mass. (c) Contrast material-enhanced sagittal T1-weighted MR image shows marked homogeneous enhancement throughout the mass. (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of the pathologic specimen shows a prominent plexiform capillary pattern, cellularity, an abundance of myxoid material, and lipoblasts.

View larger version (195K): [in a new window]   Figure 1d.   Myxoid liposarcoma with a typical appearance and homogeneous enhancement. (a) Sagittal T1-weighted MR image shows linear high-signal-intensity foci of fat within a predominantly low-signal-intensity mass. (b) Sagittal T2-weighted MR image shows foci of intermediate signal intensity within the high-signal-intensity mass. (c) Contrast material-enhanced sagittal T1-weighted MR image shows marked homogeneous enhancement throughout the mass. (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of the pathologic specimen shows a prominent plexiform capillary pattern, cellularity, an abundance of myxoid material, and lipoblasts.

View larger version (107K): [in a new window]   Figure 2a.   Myxoid liposarcoma with a typical appearance and heterogeneous enhancement. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show lacy and amorphous foci of fat within a mass. (c) Gadolinium-enhanced sagittal T1-weighted MR image shows heterogeneous enhancement throughout the mass.

View larger version (114K): [in a new window]   Figure 2b.   Myxoid liposarcoma with a typical appearance and heterogeneous enhancement. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show lacy and amorphous foci of fat within a mass. (c) Gadolinium-enhanced sagittal T1-weighted MR image shows heterogeneous enhancement throughout the mass.

View larger version (117K): [in a new window]   Figure 2c.   Myxoid liposarcoma with a typical appearance and heterogeneous enhancement. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show lacy and amorphous foci of fat within a mass. (c) Gadolinium-enhanced sagittal T1-weighted MR image shows heterogeneous enhancement throughout the mass.

View larger version (128K): [in a new window]   Figure 3a.   Multiloculated myxoid liposarcoma. (a) Axial T1-weighted MR image shows lacy and amorphous high-signal-intensity foci of fat within a mass. The mass is multiloculated and located in the intramuscular and subcutaneous tissue. (b) Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement.

View larger version (125K): [in a new window]   Figure 3b.   Multiloculated myxoid liposarcoma. (a) Axial T1-weighted MR image shows lacy and amorphous high-signal-intensity foci of fat within a mass. The mass is multiloculated and located in the intramuscular and subcutaneous tissue. (b) Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement.

View larger version (111K): [in a new window]   Figure 4a.   Myxoid liposarcoma with a cystic appearance at nonenhanced MR imaging. (a, b) Coronal T1-weighted (a) and axial T2-weighted (b) MR images show a well-defined cystlike lesion in the subcutaneous tissue (arrows). (c) Gadolinium-enhanced coronal T1-weighted MR image shows heterogeneous enhancement with a line of demarcation between the enhancing and nonenhancing regions (arrowheads). (d) Longitudinal US scan shows a complex, hypoechoic mass that does not meet the criteria for a simple cyst. (e) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a line of demarcation (arrows) between an area of compact cellularity with a typical vascular and myxoid pattern (left side of image) and an area of reduced cellularity (right side of image).

View larger version (104K): [in a new window]   Figure 4b.   Myxoid liposarcoma with a cystic appearance at nonenhanced MR imaging. (a, b) Coronal T1-weighted (a) and axial T2-weighted (b) MR images show a well-defined cystlike lesion in the subcutaneous tissue (arrows). (c) Gadolinium-enhanced coronal T1-weighted MR image shows heterogeneous enhancement with a line of demarcation between the enhancing and nonenhancing regions (arrowheads). (d) Longitudinal US scan shows a complex, hypoechoic mass that does not meet the criteria for a simple cyst. (e) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a line of demarcation (arrows) between an area of compact cellularity with a typical vascular and myxoid pattern (left side of image) and an area of reduced cellularity (right side of image).

View larger version (124K): [in a new window]   Figure 4c.   Myxoid liposarcoma with a cystic appearance at nonenhanced MR imaging. (a, b) Coronal T1-weighted (a) and axial T2-weighted (b) MR images show a well-defined cystlike lesion in the subcutaneous tissue (arrows). (c) Gadolinium-enhanced coronal T1-weighted MR image shows heterogeneous enhancement with a line of demarcation between the enhancing and nonenhancing regions (arrowheads). (d) Longitudinal US scan shows a complex, hypoechoic mass that does not meet the criteria for a simple cyst. (e) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a line of demarcation (arrows) between an area of compact cellularity with a typical vascular and myxoid pattern (left side of image) and an area of reduced cellularity (right side of image).

View larger version (120K): [in a new window]   Figure 4d.   Myxoid liposarcoma with a cystic appearance at nonenhanced MR imaging. (a, b) Coronal T1-weighted (a) and axial T2-weighted (b) MR images show a well-defined cystlike lesion in the subcutaneous tissue (arrows). (c) Gadolinium-enhanced coronal T1-weighted MR image shows heterogeneous enhancement with a line of demarcation between the enhancing and nonenhancing regions (arrowheads). (d) Longitudinal US scan shows a complex, hypoechoic mass that does not meet the criteria for a simple cyst. (e) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a line of demarcation (arrows) between an area of compact cellularity with a typical vascular and myxoid pattern (left side of image) and an area of reduced cellularity (right side of image).

View larger version (184K): [in a new window]   Figure 4e.   Myxoid liposarcoma with a cystic appearance at nonenhanced MR imaging. (a, b) Coronal T1-weighted (a) and axial T2-weighted (b) MR images show a well-defined cystlike lesion in the subcutaneous tissue (arrows). (c) Gadolinium-enhanced coronal T1-weighted MR image shows heterogeneous enhancement with a line of demarcation between the enhancing and nonenhancing regions (arrowheads). (d) Longitudinal US scan shows a complex, hypoechoic mass that does not meet the criteria for a simple cyst. (e) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a line of demarcation (arrows) between an area of compact cellularity with a typical vascular and myxoid pattern (left side of image) and an area of reduced cellularity (right side of image).

View larger version (102K): [in a new window]   Figure 5a.   Biloculated liposarcoma with a peculiar enhancement pattern. (a) Axial T1-weighted MR image shows a biloculated, low-signal-intensity mass in the deep soft tissue of the distal thigh (arrows). (b, c) Gadolinium-enhanced coronal T1-weighted MR images show no enhancement of the anterior portion of the mass (arrows in b) and nearly complete enhancement of the posterior portion except for the center (arrows in c).

View larger version (112K): [in a new window]   Figure 5b.   Biloculated liposarcoma with a peculiar enhancement pattern. (a) Axial T1-weighted MR image shows a biloculated, low-signal-intensity mass in the deep soft tissue of the distal thigh (arrows). (b, c) Gadolinium-enhanced coronal T1-weighted MR images show no enhancement of the anterior portion of the mass (arrows in b) and nearly complete enhancement of the posterior portion except for the center (arrows in c).

View larger version (114K): [in a new window]   Figure 5c.   Biloculated liposarcoma with a peculiar enhancement pattern. (a) Axial T1-weighted MR image shows a biloculated, low-signal-intensity mass in the deep soft tissue of the distal thigh (arrows). (b, c) Gadolinium-enhanced coronal T1-weighted MR images show no enhancement of the anterior portion of the mass (arrows in b) and nearly complete enhancement of the posterior portion except for the center (arrows in c).

View larger version (90K): [in a new window]   Figure 6a.   Nonenhancing myxoid liposarcoma with a misleadingly benign appearance. (a) Axial T2-weighted MR image shows a well-defined high-signal-intensity mass adjacent to the femur. (b) Axial T1-weighted MR image shows subtle high-signal-intensity septa of fat within the predominantly low-signal-intensity mass (arrows). (c) Gadolinium-enhanced axial T1-weighted MR image shows no enhancement of the mass (arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows reduced cellularity. (e) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows hemorrhagic necrosis.

View larger version (97K): [in a new window]   Figure 6b.   Nonenhancing myxoid liposarcoma with a misleadingly benign appearance. (a) Axial T2-weighted MR image shows a well-defined high-signal-intensity mass adjacent to the femur. (b) Axial T1-weighted MR image shows subtle high-signal-intensity septa of fat within the predominantly low-signal-intensity mass (arrows). (c) Gadolinium-enhanced axial T1-weighted MR image shows no enhancement of the mass (arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows reduced cellularity. (e) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows hemorrhagic necrosis.

View larger version (105K): [in a new window]   Figure 6c.   Nonenhancing myxoid liposarcoma with a misleadingly benign appearance. (a) Axial T2-weighted MR image shows a well-defined high-signal-intensity mass adjacent to the femur. (b) Axial T1-weighted MR image shows subtle high-signal-intensity septa of fat within the predominantly low-signal-intensity mass (arrows). (c) Gadolinium-enhanced axial T1-weighted MR image shows no enhancement of the mass (arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows reduced cellularity. (e) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows hemorrhagic necrosis.

View larger version (170K): [in a new window]   Figure 6d.   Nonenhancing myxoid liposarcoma with a misleadingly benign appearance. (a) Axial T2-weighted MR image shows a well-defined high-signal-intensity mass adjacent to the femur. (b) Axial T1-weighted MR image shows subtle high-signal-intensity septa of fat within the predominantly low-signal-intensity mass (arrows). (c) Gadolinium-enhanced axial T1-weighted MR image shows no enhancement of the mass (arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows reduced cellularity. (e) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows hemorrhagic necrosis.

View larger version (186K): [in a new window]   Figure 6e.   Nonenhancing myxoid liposarcoma with a misleadingly benign appearance. (a) Axial T2-weighted MR image shows a well-defined high-signal-intensity mass adjacent to the femur. (b) Axial T1-weighted MR image shows subtle high-signal-intensity septa of fat within the predominantly low-signal-intensity mass (arrows). (c) Gadolinium-enhanced axial T1-weighted MR image shows no enhancement of the mass (arrows). (d) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows reduced cellularity. (e) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows hemorrhagic necrosis.

View larger version (126K): [in a new window]   Figure 7a.   Combination of myxoid and well-differentiated liposarcoma. (a) Axial T1-weighted MR image shows a predominantly low-signal-intensity mass with faint high-signal-intensity foci occupying the right gluteus maximus muscle. A focal area of the well-differentiated subtype appears as a minor nodular component with signal intensity equal to that of fat (arrows). (b) Gadolinium-enhanced axial T1-weighted MR image shows heterogeneous enhancement of only the myxoid subtype. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a sharply defined border (arrows) between the well-differentiated subtype (left side of image) and the myxoid subtype (right side of image).

View larger version (133K): [in a new window]   Figure 7b.   Combination of myxoid and well-differentiated liposarcoma. (a) Axial T1-weighted MR image shows a predominantly low-signal-intensity mass with faint high-signal-intensity foci occupying the right gluteus maximus muscle. A focal area of the well-differentiated subtype appears as a minor nodular component with signal intensity equal to that of fat (arrows). (b) Gadolinium-enhanced axial T1-weighted MR image shows heterogeneous enhancement of only the myxoid subtype. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a sharply defined border (arrows) between the well-differentiated subtype (left side of image) and the myxoid subtype (right side of image).

View larger version (167K): [in a new window]   Figure 7c.   Combination of myxoid and well-differentiated liposarcoma. (a) Axial T1-weighted MR image shows a predominantly low-signal-intensity mass with faint high-signal-intensity foci occupying the right gluteus maximus muscle. A focal area of the well-differentiated subtype appears as a minor nodular component with signal intensity equal to that of fat (arrows). (b) Gadolinium-enhanced axial T1-weighted MR image shows heterogeneous enhancement of only the myxoid subtype. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a sharply defined border (arrows) between the well-differentiated subtype (left side of image) and the myxoid subtype (right side of image).

View larger version (123K): [in a new window]   Figure 8a.   Recurrent myxoid liposarcoma with a cystic appearance. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a homogeneous, cystlike mass in the intermuscular tissue (arrowheads). The mass had recurred 4 years after excision. (c) Gadolinium-enhanced axial fat-suppressed MR image shows that the lesion is solid with homogeneous enhancement (arrowheads).

View larger version (113K): [in a new window]   Figure 8b.   Recurrent myxoid liposarcoma with a cystic appearance. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a homogeneous, cystlike mass in the intermuscular tissue (arrowheads). The mass had recurred 4 years after excision. (c) Gadolinium-enhanced axial fat-suppressed MR image shows that the lesion is solid with homogeneous enhancement (arrowheads).

View larger version (119K): [in a new window]   Figure 8c.   Recurrent myxoid liposarcoma with a cystic appearance. (a, b) Axial T1-weighted (a) and T2-weighted (b) MR images show a homogeneous, cystlike mass in the intermuscular tissue (arrowheads). The mass had recurred 4 years after excision. (c) Gadolinium-enhanced axial fat-suppressed MR image shows that the lesion is solid with homogeneous enhancement (arrowheads).

View larger version (99K): [in a new window]   Figure 9a.   Seroma. (a) Axial T2-weighted MR image shows a homogeneous, high-signal-intensity lesion within a muscle of the thigh (arrows). Disruption of other thigh muscles is also seen. (b) Gadolinium-enhanced axial T1-weighted MR image shows only rim enhancement (arrows).

View larger version (85K): [in a new window]   Figure 9b.   Seroma. (a) Axial T2-weighted MR image shows a homogeneous, high-signal-intensity lesion within a muscle of the thigh (arrows). Disruption of other thigh muscles is also seen. (b) Gadolinium-enhanced axial T1-weighted MR image shows only rim enhancement (arrows).

View larger version (141K): [in a new window]   Figure 10a.   Multicentric myxoid liposarcoma. (a) Gadolinium-enhanced axial T1-weighted MR image shows a heterogeneously enhancing mass in the thigh (arrows). (b) Gadolinium-enhanced sagittal T1-weighted MR image shows a focal area of enhancement within a predominantly low-signal-intensity mass in the retroperitoneum. The mass represented a second myxoid liposarcoma, which occurred 2 years after the initial surgery.

View larger version (150K): [in a new window]   Figure 10b.   Multicentric myxoid liposarcoma. (a) Gadolinium-enhanced axial T1-weighted MR image shows a heterogeneously enhancing mass in the thigh (arrows). (b) Gadolinium-enhanced sagittal T1-weighted MR image shows a focal area of enhancement within a predominantly low-signal-intensity mass in the retroperitoneum. The mass represented a second myxoid liposarcoma, which occurred 2 years after the initial surgery.

View larger version (110K): [in a new window]   Figure 11a.   Extraskeletal myxoid chondrosarcoma. (a) Axial T1-weighted MR image shows a well-defined, lobulated, low-signal-intensity mass in the right gluteus maximus muscle (arrows). (b) Axial T2-weighted MR image shows that the mass has heterogeneous high signal intensity (arrows). (c) Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement of the mass (arrows). c. Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement of the mass (arrows).

View larger version (119K): [in a new window]   Figure 11b.   Extraskeletal myxoid chondrosarcoma. (a) Axial T1-weighted MR image shows a well-defined, lobulated, low-signal-intensity mass in the right gluteus maximus muscle (arrows). (b) Axial T2-weighted MR image shows that the mass has heterogeneous high signal intensity (arrows). (c) Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement of the mass (arrows). c. Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement of the mass (arrows).

View larger version (131K): [in a new window]   Figure 11c.   Extraskeletal myxoid chondrosarcoma. (a) Axial T1-weighted MR image shows a well-defined, lobulated, low-signal-intensity mass in the right gluteus maximus muscle (arrows). (b) Axial T2-weighted MR image shows that the mass has heterogeneous high signal intensity (arrows). (c) Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement of the mass (arrows). c. Contrast-enhanced axial T1-weighted MR image shows heterogeneous enhancement of the mass (arrows).

View larger version (116K): [in a new window]   Figure 12a.   Intramuscular myxoma. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a well-defined, cystic, intramuscular mass (arrows). (c) Gadolinium-enhanced sagittal T1-weighted MR image shows heterogeneous enhancement throughout the mass (arrows).

View larger version (120K): [in a new window]   Figure 12b.   Intramuscular myxoma. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a well-defined, cystic, intramuscular mass (arrows). (c) Gadolinium-enhanced sagittal T1-weighted MR image shows heterogeneous enhancement throughout the mass (arrows).

View larger version (119K): [in a new window]   Figure 12c.   Intramuscular myxoma. (a, b) Sagittal T1-weighted (a) and T2-weighted (b) MR images show a well-defined, cystic, intramuscular mass (arrows). (c) Gadolinium-enhanced sagittal T1-weighted MR image shows heterogeneous enhancement throughout the mass (arrows).

View larger version (90K): [in a new window]   Figure 13a.   Ganglion within a muscle bundle. (a) Coronal T1-weighted MR image shows a lobulated, septated, hypointense mass (arrows). (b) Coronal T2-weighted MR image shows the mass as hyperintense. (c) Gadolinium-enhanced coronal T1-weighted MR image shows thick peripheral enhancement.

View larger version (96K): [in a new window]   Figure 13b.   Ganglion within a muscle bundle. (a) Coronal T1-weighted MR image shows a lobulated, septated, hypointense mass (arrows). (b) Coronal T2-weighted MR image shows the mass as hyperintense. (c) Gadolinium-enhanced coronal T1-weighted MR image shows thick peripheral enhancement.

View larger version (105K): [in a new window]   Figure 13c.   Ganglion within a muscle bundle. (a) Coronal T1-weighted MR image shows a lobulated, septated, hypointense mass (arrows). (b) Coronal T2-weighted MR image shows the mass as hyperintense. (c) Gadolinium-enhanced coronal T1-weighted MR image shows thick peripheral enhancement.

View larger version (102K): [in a new window]   Figure 14a.   Epidermoid cyst. (a) Coronal T1-weighted MR image shows a well-defined, homogeneous, low-signal-intensity mass in the perineal region. (b) Coronal T2-weighted MR image shows the mass as hyperintense. (c) Gadolinium-enhanced coronal T1-weighted MR image shows no enhancement of the mass.

View larger version (103K): [in a new window]   Figure 14b.   Epidermoid cyst. (a) Coronal T1-weighted MR image shows a well-defined, homogeneous, low-signal-intensity mass in the perineal region. (b) Coronal T2-weighted MR image shows the mass as hyperintense. (c) Gadolinium-enhanced coronal T1-weighted MR image shows no enhancement of the mass.

View larger version (107K): [in a new window]   Figure 14c.   Epidermoid cyst. (a) Coronal T1-weighted MR image shows a well-defined, homogeneous, low-signal-intensity mass in the perineal region. (b) Coronal T2-weighted MR image shows the mass as hyperintense. (c) Gadolinium-enhanced coronal T1-weighted MR image shows no enhancement of the mass.