Pseudotumoural soft tissue lesions of the hand and wrist: a pictorial review

Abstract

Mimickers of soft tissue tumours in the hand and wrist are more frequent than true neoplastic lesions. Pseudotumours belong to a large and heterogeneous group of disorders, varying from normal anatomical variants, cystic lesions, post-traumatic lesions, skin lesions, inflammatory and infectious lesions, non-neoplastic vascular lesions, metabolic disorders (crystal deposition disease and amyloidosis) and miscellaneous disorders. Although the imaging approach to pseudotumoural lesions is often very similar to the approach to “true” soft tissue tumoral counterparts, further management of these lesions is different. Biopsy should be performed only in doubtful cases, when the diagnosis is unclear. Therefore, the radiologist plays a pivotal role in the diagnosis of these lesions. Awareness of the normal anatomy and existence and common imaging presentation of these diseases, in combination with relevant clinical findings (clinical history, age, location and skin changes), enables the radiologist to make the correct diagnosis in most cases, thereby limiting the need for invasive procedures.

Soft tissue pseudotumours: a pictorial review with emphasis on MRI

“…Ligamentous aponeuroses may undergo a post-traumatic proliferative process with the most common location in the plantar aponeurosis [1][2][3]26 . Plantar fasciitisplantar fibromatosis occur in the proximal insertional site and in the central portion of the medial plantar aponeurosis of the foot and represent one of the most common causes of heel pain.…”

“…It has been related to other forms of superficial fibromatoses (e.g., Dupuytren's contracture, Peyronie's disease), and may coexist with these fibromatoses in the same patient. Bilateral lesions are also common [1][2][3]26 . At MR imaging, fasciitis-fibromatosis is depicted as a nodular lesion located in the involved aponeurosis with decreased signal intensity on both T1-weighted and T2-weighted images.…”

“…Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disorder of the synovium, which may affect joints and bursae in a diffuse or focal form 1,27,28 . On MR imaging, the mass-like proliferative synovium may be interpreted as an aggressive mass.…”

“…A wide range of tumour-like conditions of the soft tissues may be encountered in clinical practice or when patients undergo radiologic examinations 1 . Although advances in cross sectional imaging (ultrasound, MD-CT and MRI) play a pivotal role in the correct evaluation of tumour-like lesions, a systematic approach is needed to achieve a definitive diagnosis or limit the differential diagnosis [1][2][3] .…”

“…Although advances in cross sectional imaging (ultrasound, MD-CT and MRI) play a pivotal role in the correct evaluation of tumour-like lesions, a systematic approach is needed to achieve a definitive diagnosis or limit the differential diagnosis [1][2][3] . Clinical history, physical examination and anatomic location are of paramount importance [1][2][3] . This pictorial essay reviews some of the most frequent benign soft tissue conditions which may be mistaken for malignancy and thus lead to needless referrals, unnecessary biopsies and great anxiety to the patients and their carers.…”