DOI: 10.1148/rg.272065082
Superficial Soft-Tissue Masses: Analysis, Diagnosis, and Differential Considerations1
Francesca D. Beaman, MD2,
Mark J. Kransdorf, MD,
Tricia R. Andrews, MD,
Mark D. Murphey, MD,
Lynn K. Arcara, MD and
James H. Keeling, MD
1 From the Departments of Radiology (F.D.B., M.J.K.) and Dermatology (T.R.A., J.H.K.), Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224-3899; and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.J.K., M.D.M., L.K.A.). Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received April 26, 2006; revision requested June 12 and received July 26; accepted July 31. All authors have no financial relationships to disclose.
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Figure 2a. Exophytic dermatofibrosarcoma protuberans in the lower thigh of a 45-year-old man. (a) Axial unenhanced CT image shows a large mass with ulceration at the skin surface (arrowheads). (b) Axial short inversion time inversion recovery (4000/20/150) MR image shows extension of the protuberant mass along the skin layers and into the cutaneous and subcutaneous fat. (c) Photograph of a gross specimen cross section shows the mass with linear extension along the skin layers (arrows), features identical to those seen at imaging. Scale is in centimeters.
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Figure 2b. Exophytic dermatofibrosarcoma protuberans in the lower thigh of a 45-year-old man. (a) Axial unenhanced CT image shows a large mass with ulceration at the skin surface (arrowheads). (b) Axial short inversion time inversion recovery (4000/20/150) MR image shows extension of the protuberant mass along the skin layers and into the cutaneous and subcutaneous fat. (c) Photograph of a gross specimen cross section shows the mass with linear extension along the skin layers (arrows), features identical to those seen at imaging. Scale is in centimeters.
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Figure 2c. Exophytic dermatofibrosarcoma protuberans in the lower thigh of a 45-year-old man. (a) Axial unenhanced CT image shows a large mass with ulceration at the skin surface (arrowheads). (b) Axial short inversion time inversion recovery (4000/20/150) MR image shows extension of the protuberant mass along the skin layers and into the cutaneous and subcutaneous fat. (c) Photograph of a gross specimen cross section shows the mass with linear extension along the skin layers (arrows), features identical to those seen at imaging. Scale is in centimeters.
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Figure 3. Superficial (subcutaneous) lipoma in a 51-year-old man with a large posterior neck mass. Sagittal T1-weighted (620/17) spin-echo (SE) MR image shows a well-marginated lipomatous mass (*) in the subcutaneous fat. The signal intensity of the lesion on all MR images was identical to that of fat.
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Figure 4a. Juvenile capillary hemangioma (strawberry nevus) in a 2-month-old girl. (a) Axial unenhanced CT image shows infiltration of the skin and orbit (arrow). (b) Axial T2-weighted (2000/80) SE MR image depicts a mass (*) that has infiltrated the subcutaneous and deeper soft tissues. The signal intensity of the lesion at T2-weighted imaging was nonspecific.
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Figure 4b. Juvenile capillary hemangioma (strawberry nevus) in a 2-month-old girl. (a) Axial unenhanced CT image shows infiltration of the skin and orbit (arrow). (b) Axial T2-weighted (2000/80) SE MR image depicts a mass (*) that has infiltrated the subcutaneous and deeper soft tissues. The signal intensity of the lesion at T2-weighted imaging was nonspecific.
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Figure 5a. Multifocal cutaneous neurofibromas in a 78-year-old man with type 1 neurofibromatosis. (a) Axial CT image of the abdomen, obtained with oral and intravenous contrast material, shows multifocal isoattenuating soft-tissue masses (arrowheads) indicative of neurofibromas. (b, c) Sagittal T2-weighted turbo SE (4000/102) MR image (b) and sagittal gadolinium-enhanced fat-suppressed T1-weighted SE (650/16) MR image (c) show hyper-intense signal in the enhanced cutaneous masses (arrows).
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Figure 5b. Multifocal cutaneous neurofibromas in a 78-year-old man with type 1 neurofibromatosis. (a) Axial CT image of the abdomen, obtained with oral and intravenous contrast material, shows multifocal isoattenuating soft-tissue masses (arrowheads) indicative of neurofibromas. (b, c) Sagittal T2-weighted turbo SE (4000/102) MR image (b) and sagittal gadolinium-enhanced fat-suppressed T1-weighted SE (650/16) MR image (c) show hyper-intense signal in the enhanced cutaneous masses (arrows).
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Figure 5c. Multifocal cutaneous neurofibromas in a 78-year-old man with type 1 neurofibromatosis. (a) Axial CT image of the abdomen, obtained with oral and intravenous contrast material, shows multifocal isoattenuating soft-tissue masses (arrowheads) indicative of neurofibromas. (b, c) Sagittal T2-weighted turbo SE (4000/102) MR image (b) and sagittal gadolinium-enhanced fat-suppressed T1-weighted SE (650/16) MR image (c) show hyper-intense signal in the enhanced cutaneous masses (arrows).
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Figure 6a. Leiomyosarcoma arising from the saphenous vein in a 53-year-old man. (a) Doppler US image shows a circumscribed echogenic mass with marked hypervascularity. (b, c) Axial T1-weighted (802/17) (a) and axial T2-weighted (2350/80) (b) SE MR images show a circumscribed soft-tissue mass (arrow) in the subcutaneous adipose tissue. The signal intensity of the mass is indicative of a solid lesion. (d) Axial gadolinium-enhanced T1-weighted (675/17) fat-suppressed SE MR image shows homogeneous moderate enhancement of the mass (arrow). (e) Photograph of the gross specimen shows a lobulated mass that surrounds the saphenous vein (arrow). Scale is in centimeters.
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Figure 6b. Leiomyosarcoma arising from the saphenous vein in a 53-year-old man. (a) Doppler US image shows a circumscribed echogenic mass with marked hypervascularity. (b, c) Axial T1-weighted (802/17) (a) and axial T2-weighted (2350/80) (b) SE MR images show a circumscribed soft-tissue mass (arrow) in the subcutaneous adipose tissue. The signal intensity of the mass is indicative of a solid lesion. (d) Axial gadolinium-enhanced T1-weighted (675/17) fat-suppressed SE MR image shows homogeneous moderate enhancement of the mass (arrow). (e) Photograph of the gross specimen shows a lobulated mass that surrounds the saphenous vein (arrow). Scale is in centimeters.
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Figure 6c. Leiomyosarcoma arising from the saphenous vein in a 53-year-old man. (a) Doppler US image shows a circumscribed echogenic mass with marked hypervascularity. (b, c) Axial T1-weighted (802/17) (a) and axial T2-weighted (2350/80) (b) SE MR images show a circumscribed soft-tissue mass (arrow) in the subcutaneous adipose tissue. The signal intensity of the mass is indicative of a solid lesion. (d) Axial gadolinium-enhanced T1-weighted (675/17) fat-suppressed SE MR image shows homogeneous moderate enhancement of the mass (arrow). (e) Photograph of the gross specimen shows a lobulated mass that surrounds the saphenous vein (arrow). Scale is in centimeters.
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Figure 6d. Leiomyosarcoma arising from the saphenous vein in a 53-year-old man. (a) Doppler US image shows a circumscribed echogenic mass with marked hypervascularity. (b, c) Axial T1-weighted (802/17) (a) and axial T2-weighted (2350/80) (b) SE MR images show a circumscribed soft-tissue mass (arrow) in the subcutaneous adipose tissue. The signal intensity of the mass is indicative of a solid lesion. (d) Axial gadolinium-enhanced T1-weighted (675/17) fat-suppressed SE MR image shows homogeneous moderate enhancement of the mass (arrow). (e) Photograph of the gross specimen shows a lobulated mass that surrounds the saphenous vein (arrow). Scale is in centimeters.
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Figure 6e. Leiomyosarcoma arising from the saphenous vein in a 53-year-old man. (a) Doppler US image shows a circumscribed echogenic mass with marked hypervascularity. (b, c) Axial T1-weighted (802/17) (a) and axial T2-weighted (2350/80) (b) SE MR images show a circumscribed soft-tissue mass (arrow) in the subcutaneous adipose tissue. The signal intensity of the mass is indicative of a solid lesion. (d) Axial gadolinium-enhanced T1-weighted (675/17) fat-suppressed SE MR image shows homogeneous moderate enhancement of the mass (arrow). (e) Photograph of the gross specimen shows a lobulated mass that surrounds the saphenous vein (arrow). Scale is in centimeters.
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Figure 7a. Superficial malignant fibrous histiocytoma in the upper thigh of a 78-year-old man. (a) Coronal T1-weighted (700/13) SE MR image shows a large hypointense mass (arrows) that has arisen in the subcutaneous tissue and has invaded and penetrated the tensor fascia lata. (b) Axial T2-weighted (2540/80) SE MR image shows heterogeneously hypointense signal in the mass, as well as abnormal thickening of the tensor fascia lata (arrow).
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Figure 7b. Superficial malignant fibrous histiocytoma in the upper thigh of a 78-year-old man. (a) Coronal T1-weighted (700/13) SE MR image shows a large hypointense mass (arrows) that has arisen in the subcutaneous tissue and has invaded and penetrated the tensor fascia lata. (b) Axial T2-weighted (2540/80) SE MR image shows heterogeneously hypointense signal in the mass, as well as abnormal thickening of the tensor fascia lata (arrow).
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Figure 8a. Nodular fasciitis in the upper arm of a 16-year-old boy. Coronal T1-weighted (600/20) (a) and coronal T2-weighted (2000/80) (b) SE MR images of the shoulder show a well-defined mass superficial to the deltoid muscle with a small linear area of extension in the proximal fascia (arrow in b).
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Figure 8b. Nodular fasciitis in the upper arm of a 16-year-old boy. Coronal T1-weighted (600/20) (a) and coronal T2-weighted (2000/80) (b) SE MR images of the shoulder show a well-defined mass superficial to the deltoid muscle with a small linear area of extension in the proximal fascia (arrow in b).
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Figure 9a. Musculoskeletal fibromatosis in the paraspinal region in a 20-year-old man. (a) Axial T1-weighted (800/20) SE MR image shows markedly decreased signal intensity within a well-defined mass (arrows), a finding indicative of a densely collagenous hypocellular lesion. The mass extends across the midline (arrowheads). T2-weighted images (not shown) also showed decreased signal intensity in the mass. (b) Corresponding contrast-enhanced CT image shows enhancement of the lesion and small fascial "tails" (arrowheads).
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Figure 9b. Musculoskeletal fibromatosis in the paraspinal region in a 20-year-old man. (a) Axial T1-weighted (800/20) SE MR image shows markedly decreased signal intensity within a well-defined mass (arrows), a finding indicative of a densely collagenous hypocellular lesion. The mass extends across the midline (arrowheads). T2-weighted images (not shown) also showed decreased signal intensity in the mass. (b) Corresponding contrast-enhanced CT image shows enhancement of the lesion and small fascial "tails" (arrowheads).
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Figure 10a. Infundibular cysts at MR imaging and US. (a, b) Axial T1-weighted (600/20) (a) and axial T2-weighted (2500/80) (b) SE MR images of the knee of a 45-year-old man with a history of a mass for approximately 30 years show a well-defined but nonspecific mass (*) in the subcutaneous adipose tissue. The lesion contents appear heterogeneous on the T2-weighted image, with debris in the dependent aspect. (c) US image in a different patient shows an infundibular cyst located in the skin (arrow) and two hairs (arrowheads) emerging from the cyst.
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Figure 10b. Infundibular cysts at MR imaging and US. (a, b) Axial T1-weighted (600/20) (a) and axial T2-weighted (2500/80) (b) SE MR images of the knee of a 45-year-old man with a history of a mass for approximately 30 years show a well-defined but nonspecific mass (*) in the subcutaneous adipose tissue. The lesion contents appear heterogeneous on the T2-weighted image, with debris in the dependent aspect. (c) US image in a different patient shows an infundibular cyst located in the skin (arrow) and two hairs (arrowheads) emerging from the cyst.
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Figure 10c. Infundibular cysts at MR imaging and US. (a, b) Axial T1-weighted (600/20) (a) and axial T2-weighted (2500/80) (b) SE MR images of the knee of a 45-year-old man with a history of a mass for approximately 30 years show a well-defined but nonspecific mass (*) in the subcutaneous adipose tissue. The lesion contents appear heterogeneous on the T2-weighted image, with debris in the dependent aspect. (c) US image in a different patient shows an infundibular cyst located in the skin (arrow) and two hairs (arrowheads) emerging from the cyst.
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Figure 11. Pilomatricoma in the neck of a 7-year-old boy. Axial contrast-enhanced CT image obtained with bone window settings shows a mineralized mass (arrow) with delicate ossification that is more prominent peripherally.
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Figure 12a. Multiple facial cylindromas in a 79-year-old woman. (a) Clinical photograph of the patient’s ear shows numerous soft-tissue masses. (b) Axial unenhanced CT image shows multiple isoattenuating cutaneous masses that involve both ears.
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Figure 12b. Multiple facial cylindromas in a 79-year-old woman. (a) Clinical photograph of the patient’s ear shows numerous soft-tissue masses. (b) Axial unenhanced CT image shows multiple isoattenuating cutaneous masses that involve both ears.
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Figure 13a. Subcutaneous metastatic melanoma in a 68-year-old woman. (a, b) Sagittal T1-weighted (406/17) (a) and axial gadolinium-enhanced T1-weighted (433/17) fat-suppressed (b) SE MR images show a well-defined subcutaneous solid mass (arrow) in the posterior aspect of the right thigh. Intense homogeneous enhancement of the mass is seen in b. (c) Axial positron emission tomographic image of the thighs shows two hypermetabolic foci (arrowheads) that correspond to melanoma metastases. The lesion in the right thigh correlates with that in a and b.
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Figure 13b. Subcutaneous metastatic melanoma in a 68-year-old woman. (a, b) Sagittal T1-weighted (406/17) (a) and axial gadolinium-enhanced T1-weighted (433/17) fat-suppressed (b) SE MR images show a well-defined subcutaneous solid mass (arrow) in the posterior aspect of the right thigh. Intense homogeneous enhancement of the mass is seen in b. (c) Axial positron emission tomographic image of the thighs shows two hypermetabolic foci (arrowheads) that correspond to melanoma metastases. The lesion in the right thigh correlates with that in a and b.
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Figure 13c. Subcutaneous metastatic melanoma in a 68-year-old woman. (a, b) Sagittal T1-weighted (406/17) (a) and axial gadolinium-enhanced T1-weighted (433/17) fat-suppressed (b) SE MR images show a well-defined subcutaneous solid mass (arrow) in the posterior aspect of the right thigh. Intense homogeneous enhancement of the mass is seen in b. (c) Axial positron emission tomographic image of the thighs shows two hypermetabolic foci (arrowheads) that correspond to melanoma metastases. The lesion in the right thigh correlates with that in a and b.
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Figure 14. Subcutaneous myxoma in the lower leg of a 32-year-old man. Axial T2-weighted (2500/90) SE MR image shows a well-defined subcutaneous mass (*) anterior to the tibia. The large size of the lesion makes it difficult to determine whether its origin is in subcutaneous tissue or the aponeurosis.
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Figure 15a. Superficial B cell lymphoma in the forearm of a 53-year-old man. Axial T1-weighted (716/9) (a) and axial T2-weighted (2350/80) fat-suppressed (b) SE MR images show a large homogeneous mass (*) with nonspecific features in the cutaneous and subcutaneous compartments. The mass demonstrated signal intensity slightly higher than that in skeletal muscle at T1-weighted imaging, high signal intensity at T2-weighted imaging, and intense homogeneous enhancement at gadolinium-enhanced MR imaging.
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Figure 15b. Superficial B cell lymphoma in the forearm of a 53-year-old man. Axial T1-weighted (716/9) (a) and axial T2-weighted (2350/80) fat-suppressed (b) SE MR images show a large homogeneous mass (*) with nonspecific features in the cutaneous and subcutaneous compartments. The mass demonstrated signal intensity slightly higher than that in skeletal muscle at T1-weighted imaging, high signal intensity at T2-weighted imaging, and intense homogeneous enhancement at gadolinium-enhanced MR imaging.
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Figure 16a. Granuloma annulare in the lower leg of a 5-year-old girl. Axial T1-weighted (500/20) (a) and axial T2-weighted (2000/80) (b) SE MR images show a mass in the subcutaneous tissue of the anterior part of the leg (arrow). The lesion had decreased signal intensity and a somewhat indistinct margin on all MR images.
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Figure 16b. Granuloma annulare in the lower leg of a 5-year-old girl. Axial T1-weighted (500/20) (a) and axial T2-weighted (2000/80) (b) SE MR images show a mass in the subcutaneous tissue of the anterior part of the leg (arrow). The lesion had decreased signal intensity and a somewhat indistinct margin on all MR images.
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Figure 17a. Cat-scratch disease in a 26-year-old man with a rapidly growing, painful mass in the groin. (a) Coronal T2-weighted (5950/68) SE MR image shows a nodal mass (arrow) in the right side of the groin, with prominent associated edema (arrowhead). (b) Axial T1-weighted (600/15) SE MR image shows a large right inguinal node with surrounding edema (arrow). On MR images obtained after contrast material was administered, the node demonstrated mild heterogeneous enhancement. The findings were indicative of lymphadenopathy.
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Figure 17b. Cat-scratch disease in a 26-year-old man with a rapidly growing, painful mass in the groin. (a) Coronal T2-weighted (5950/68) SE MR image shows a nodal mass (arrow) in the right side of the groin, with prominent associated edema (arrowhead). (b) Axial T1-weighted (600/15) SE MR image shows a large right inguinal node with surrounding edema (arrow). On MR images obtained after contrast material was administered, the node demonstrated mild heterogeneous enhancement. The findings were indicative of lymphadenopathy.
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Figure 18a. Necrotizing fasciitis in a 51-year-old diabetic man with rapidly progressing pain and swelling in the thigh. (a, b) Axial T1-weighted (716/15) (a) and axial fat-suppressed T2-weighted (6566/105) (b) SE MR images show a reticulated pattern of abnormal signal intensity within the subcutaneous tissues, a pattern suggestive of cellulitis; an extensive region of abnormal signal intensity (*) centered on the fascia, a finding indicative of fasciitis; and areas of abnormal signal intensity in the adjacent muscle (arrows in b), features indicative of associated myositis. (c) Axial T1-weighted (650/15) SE MR image obtained after the administration of intravenous gadolinium shows nonenhanced fascial tissue laterally (*) and anteriorly. Necrosis of the fascia (necrotizing fasciitis) was identified at surgery.
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Figure 18b. Necrotizing fasciitis in a 51-year-old diabetic man with rapidly progressing pain and swelling in the thigh. (a, b) Axial T1-weighted (716/15) (a) and axial fat-suppressed T2-weighted (6566/105) (b) SE MR images show a reticulated pattern of abnormal signal intensity within the subcutaneous tissues, a pattern suggestive of cellulitis; an extensive region of abnormal signal intensity (*) centered on the fascia, a finding indicative of fasciitis; and areas of abnormal signal intensity in the adjacent muscle (arrows in b), features indicative of associated myositis. (c) Axial T1-weighted (650/15) SE MR image obtained after the administration of intravenous gadolinium shows nonenhanced fascial tissue laterally (*) and anteriorly. Necrosis of the fascia (necrotizing fasciitis) was identified at surgery.
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Figure 18c. Necrotizing fasciitis in a 51-year-old diabetic man with rapidly progressing pain and swelling in the thigh. (a, b) Axial T1-weighted (716/15) (a) and axial fat-suppressed T2-weighted (6566/105) (b) SE MR images show a reticulated pattern of abnormal signal intensity within the subcutaneous tissues, a pattern suggestive of cellulitis; an extensive region of abnormal signal intensity (*) centered on the fascia, a finding indicative of fasciitis; and areas of abnormal signal intensity in the adjacent muscle (arrows in b), features indicative of associated myositis. (c) Axial T1-weighted (650/15) SE MR image obtained after the administration of intravenous gadolinium shows nonenhanced fascial tissue laterally (*) and anteriorly. Necrosis of the fascia (necrotizing fasciitis) was identified at surgery.
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Copyright © 2007 by the Radiological Society of North America.
