Page 36 - Delaware Medical Journal - May/June 2019
P. 36
The patient was taken to the operating room for radical resection of the lesion with en bloc partial resection of the vastus intermedius muscle. Frozen sections demonstrated microscopically negative margins. Immediate reconstruction was performed by plastic surgery, utilizing a
Evaluation of the gross specimen revealed
rubbery mass measuring 5.0 x 4.2 x 1.2 cm. Microscopic examination demonstrated
mesenchymal neoplasm consisting of bland spindle cells in a loosely cohesive hypocellular stroma with ropey collagen proliferation. The neoplasm diffusely muscle, and traversed fascial planes.
There was no evidence of malignant transformation. Despite being poorly pathologic margins.
Postoperatively, the patient experienced
no surgical complications, had good functional recovery, and quickly returned
or appreciable muscle weakness. MRI months after surgery showed no evidence for residual tumor or local tumor recurrence.
DISCUSSION
The existing literature describing the
tissues is limited to a few case reports. In a
revealed a circumscribed, heterogeneous soft tissue mass with markedly hyperintense T2 signal, slightly hypointense-to-isointense T1 signal relative to skeletal muscle, and diffuse post-contrast enhancement. In a second case report from 2017, MRI examination exhibited hyperintense T2 signal, isointense T1
signal relative to skeletal muscle, and strong peripheral enhancement.4
in our case more closely resembled the former, with homogeneous, avid post- contrast enhancement. Variability in imaging may be related to tissue composition, with varying amounts of blood vessels, spindle cells, myxoid, and collagenous stroma determining the enhancement pattern and signal characteristics, as suggested by Hashino et al.4 Hypointense to isointense T1 signal and hyperintense T2 signal appear
5
Our case differs from previously reported cases of AFSTs in that it demonstrates the spread. On MRI examination, the lesion was the iliotibial band and into the adjacent vastus intermedius muscle. Transfascial spread
histologic evaluation. Our case illustrates
more aggressive imaging features, further
Hardcastle Gallery
Turn your collectables and medical artifacts into artistic treasures.
5714 Kennett Pike Centreville, De 19807 302.655.5230
The Delaware Medical Journal is accepting article submissions for publication.
The DMJ publishes scientific articles, case reports, opinion pieces, book reviews, and other medical
articles of interest.
For complete instructions go to https://tinyurl.com/2019DMJ
Submissions should be sent to Mary.Fenimore@medsocdel.org or
Delaware Medical Journal
Medical Society of Delaware 900 Prides Crossing Newark, DE 19713
Get Your Work Published!
