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Parasacral malignant fibrous histiocytoma presenting with low back pain
ARTICLE IN PRESS
The Spine Journal ■■ (2015) ■■–■■
Images of Spine Care Parasacral malignant fibrous histiocytoma presenting with low back pain Introduction A 54-year-old man presented with complaints of low back pain and sacrococcygeal numbness. His past medical history was unremarkable. Physical examination revealed a palpable mass in the right parasacral region. Magnetic resonance imaging showed a relatively well-circumscribed soft tissue mass (45×40×38 mm), which was located within the paraspinal muscle in the right parasacral region (Fig. 1). The lesion extended to the sacrum anteriorly, and the right gluteus maximus muscle posteroinferiorly. It was iso- to mildly hypointense to muscle on T1-weighted images, and heterogeneously hyperintense on T2-weighted images. Post-contrast images demonstrated heterogeneous, intense enhancement of the lesion (Fig. 2). Computed tomography scan showed the absence of
calcifications within the lesion. Density of the lesion was similar to adjacent muscle. The lesion extended into the S2 right neural foramen, and caused thinning and remodeling of the adjacent sacral cortex (Fig. 1). Ultrasonography guided core biopsy of the lesion was performed, and histologic examination revealed the diagnosis of malignant fibrous histiocytoma. Malignant fibrous histiocytoma, which is also known as pleomorphic undifferentiated sarcoma, is the most common type of soft tissue sarcoma in adults. Histiocytomas can occur anywhere in the body but most commonly involve the proximal extremities (70%–75%) and retroperitoneal space (15%). They are generally confined to the soft tissues but sometimes may arise in or from bone. They usually manifest as painless and large soft tissue masses with progressive enlargement [1].
Reference [1] Murphey MD, Gross TM, Rosenthal HG. From the archives of the AFIP. Musculoskeletal malignant fibrous histiocytoma: radiologic-pathologic correlation. Radiographics 1994;14:807–26.
Fig. 1. Axial computed tomography (Left) and T2-weighted magnetic resonance image (Right) show a large, well-circumscribed soft tissue mass located in the right parasacral region (white arrows). Extension of the lesion into the S2 right neural foramen is also seen (red arrow). http://dx.doi.org/10.1016/j.spinee.2015.11.064 1529-9430/© 2015 Elsevier Inc. All rights reserved.
ARTICLE IN PRESS 2
C. Kafadar et al. / The Spine Journal ■■ (2015) ■■–■■
Fig. 2. Contrast-enhanced T1-weighted images with fat suppression in the axial (Left) and sagittal (Right) plane show a heterogeneous, prominent enhancement of the lesion (arrows).
Cahit Kafadar, MD Mehmet Incedayi, MD Guner Sonmez, MD Hakan Mutlu, MD Department of Radiology GATA Haydarpasa Teaching Hospital Tıbbiye Street, Uskudar Istanbul, 34668, Turkey
FDA device/drug status: Not applicable. Author disclosures: CK: Nothing to disclose. MI: Nothing to disclose. GS: Nothing to disclose. HM: Nothing to disclose. The authors declare no conflict of interest.
The Spine Journal ■■ (2015) ■■–■■
Images of Spine Care Parasacral malignant fibrous histiocytoma presenting with low back pain Introduction A 54-year-old man presented with complaints of low back pain and sacrococcygeal numbness. His past medical history was unremarkable. Physical examination revealed a palpable mass in the right parasacral region. Magnetic resonance imaging showed a relatively well-circumscribed soft tissue mass (45×40×38 mm), which was located within the paraspinal muscle in the right parasacral region (Fig. 1). The lesion extended to the sacrum anteriorly, and the right gluteus maximus muscle posteroinferiorly. It was iso- to mildly hypointense to muscle on T1-weighted images, and heterogeneously hyperintense on T2-weighted images. Post-contrast images demonstrated heterogeneous, intense enhancement of the lesion (Fig. 2). Computed tomography scan showed the absence of
calcifications within the lesion. Density of the lesion was similar to adjacent muscle. The lesion extended into the S2 right neural foramen, and caused thinning and remodeling of the adjacent sacral cortex (Fig. 1). Ultrasonography guided core biopsy of the lesion was performed, and histologic examination revealed the diagnosis of malignant fibrous histiocytoma. Malignant fibrous histiocytoma, which is also known as pleomorphic undifferentiated sarcoma, is the most common type of soft tissue sarcoma in adults. Histiocytomas can occur anywhere in the body but most commonly involve the proximal extremities (70%–75%) and retroperitoneal space (15%). They are generally confined to the soft tissues but sometimes may arise in or from bone. They usually manifest as painless and large soft tissue masses with progressive enlargement [1].
Reference [1] Murphey MD, Gross TM, Rosenthal HG. From the archives of the AFIP. Musculoskeletal malignant fibrous histiocytoma: radiologic-pathologic correlation. Radiographics 1994;14:807–26.
Fig. 1. Axial computed tomography (Left) and T2-weighted magnetic resonance image (Right) show a large, well-circumscribed soft tissue mass located in the right parasacral region (white arrows). Extension of the lesion into the S2 right neural foramen is also seen (red arrow). http://dx.doi.org/10.1016/j.spinee.2015.11.064 1529-9430/© 2015 Elsevier Inc. All rights reserved.
ARTICLE IN PRESS 2
C. Kafadar et al. / The Spine Journal ■■ (2015) ■■–■■
Fig. 2. Contrast-enhanced T1-weighted images with fat suppression in the axial (Left) and sagittal (Right) plane show a heterogeneous, prominent enhancement of the lesion (arrows).
Cahit Kafadar, MD Mehmet Incedayi, MD Guner Sonmez, MD Hakan Mutlu, MD Department of Radiology GATA Haydarpasa Teaching Hospital Tıbbiye Street, Uskudar Istanbul, 34668, Turkey
FDA device/drug status: Not applicable. Author disclosures: CK: Nothing to disclose. MI: Nothing to disclose. GS: Nothing to disclose. HM: Nothing to disclose. The authors declare no conflict of interest.