Small (≤5 cm) soft tissue tumors of the extremity and superficial trunk: MRI features and demographic characteristics associated with malignancy

Abstract

Background Although a substantial proportion of small soft tissue tumors are malignant, magnetic resonance imaging (MRI) features and demographic characteristics associated with these tumors have not been well described. Purpose To investigate the MRI features and demographic characteristics associated with small (≤5 cm) malignant soft tissue tumors, and to identify independent predictors that allow differentiation of small benign and malignant soft tissue tumors. Material and Methods This retrospective study evaluated patients who underwent surgical excision of small soft tissue tumors of the extremities and superficial trunk, and preoperative contrast-enhanced MRI. Seven MRI findings (tumor depth, tumor-fascia relationship, heterogeneity of signal intensity, necrosis, peritumoral edema, peritumoral enhancement, and margin) and two demographic parameters (age and sex) were included in univariate and multivariate logistic regression analyses to identify independent predictors of small malignant soft tissue tumors. Results A total of 221 patients (102 men; mean age=45.6 ± 17.6 years) with 72 malignant and 149 benign tumors were included. In the univariate analysis, peritumoral edema (odds ratio [OR] = 3.854; P < 0.001) and peritumoral enhancement (OR = 3.966; P < 0.001) and patient age (≥46 years) (OR = 2.154; P = 0.009) were significantly associated with malignancy. Multivariate analysis showed that peritumoral enhancement on MRI (OR = 3.728; P < 0.001) and patient age (≥46 years) (OR = 1.907; P = 0.036) were independent predictors of malignancy. The combination of these two parameters showed accuracy of 75.1%, sensitivity of 55.6%, and specificity of 84.6% to predict malignancy. Conclusion Among several MRI and demographic features, the presence of peritumoral enhancement on MRI and patient age (≥46 years) were independent predictors of malignancy in small soft tissue tumors.

Case report: Giant atypical granular cell tumor of the median nerve

“…Histopathological examination is the gold standard for the diagnosis of GCTs (25). Tumor cells are usually arranged in sheets or cords, which was consistent with this case.…”

“…In this case, the tumor was surrounded by hyperintensity. In general soft tissue tumors, this phenomenon usually indicates that the tumor is malignant (25). However, for GCT, peripheral hyperintensities may be due to compression of the surrounding tissues or severe inflammation with lymphocyte infiltration around the tumor rather than specific signs suggestive of malignancy (24, 26).…”