• Multimodality approach is needed for diagnostic evaluation of soft tissue sarcomas.
• CT and MRI play an important role in characterization of masses,
extension and involvement of adjacent structures.
• PET CT plays a crucial role for detection of early metastasis,
biopsy guidance,
response assessment,
follow up and prognosis.
• Histopathology is very important to characterize the subtypes,
since different subtypes have varied prognosis and treatment strategies.
Case 1: 48 years,
Male.
FDG PET CT:
• Large heterogeneous mass lesion in the lower presternal and epigastric regions,
measuring approximately 11.2 x 7.5 cm in transaxial dimensions and 10 cm craniocaudally.
• The mass is infiltrating the lower chest wall muscles without bony erosions.
Histopathology :
Dermatofibrosarcoma protuberans.
Case 2: 40 years,
Male.
FDG PET CT:
• Large metabolically active enhancing mass is noted epicentered over the right pulmonary artery extending to the right hilar / perihilar regions laterally and into the main and proximal most left pulmonary artery medially.
• There is adjacent pericardial thickening with deposit over the surface of right atrium.
• Infiltration of the lower SVC with mass effect over the lower SVC and right atrium.
• Pericardial effusion with pericardial thickening.
The right atrial surface lesion is contiguous with the pulmonary artery mass.
Diagnosis: Pulmonary sarcoma
Case 3: 9 years,
Male.
FDG PET CT:
• There is large heterogeneously enhancing infiltrating tongue mass.
• There are multiple slightly enlarged level II cervical lymph nodes.
• Innumerable well-defined bilateral lung nodules are seen.
Histopathology:
• Alveolar sarcoma of tongue with pulmonary metastasis.
Case 4: 61 years,
Male.
FDG PET CT:
• Metabolically active heterogeneously enhancing irregular mass lesion at the right renal hilum,
inferior to the right renal vein displacing the right kidney laterally,
abutting and infiltrating the right postero-lateral wall of the infrarenal inferior venacava
• Few discrete paracaval and aortocaval lymph nodes – of concern for metastases.
• Few discrete bilateral pleuro-pulmonary nodules,
of concern for metastases.
Recommend follow up.
• Histopathology : Leiomyosarcoma of IVC
Case 5: 68 years,
Female.
FDG PET CT:
• Diffuse right parieto-occipital and posterior temporal scalp thickening with subgaleal soft tissue thickening and nodules.
Histopathology: Angiosarcoma of scalp
Case 6: 26 years,
Female.
FDG PET CT:
• Large lobulated heterogeneously enhancing soft tissue mass lesion in the right lateral abdominal wall,
extending inferiorly along the right anterior iliac region
• Two discrete metabolically active soft tissue nodules in the right lateral abdominal wall,
superior to above mentioned lesion.
Histopathology:
Recurrent Fibrosarcoma of left lateral abdominal wall.
Case 7: 60 years,
Male.
MRI Left thumb:
• There is large lobulated T2 / STIR hyperintense destructive mass lesion involving the distal phalanx,
nail and skin of the left thumb and destruction of the overlying flexor tendon with diffusion restriction.
• DCE shows type II curve pattern.
Histopathology:
• Squamous cell sarcoma of left thumb.
Case 8: 41 years,
Female.
FDG PET CT:
• Enhancing soft tissue density mass is seen in the posterior and medial aspects of the right ankle deep to the Achilles tendon and abutting the posterior surface of distal tibia,
talus and fibula without osseous erosions.
• No obvious extension into the ankle joint.
Histopathology:
Synovial sarcoma of right ankle.
Case 9: 60 years,
Female.
FDG PET CT:
• Large retroperitoneal mass lesion with fat and soft tissue density lobulated components with mass effect over the right kidney and adjoining structures with extrinsic compression of right mid ureter,
resulting in moderate right hydroureteronephrosis.
• Few nodular lesions in the anterior segment of right upper lobe and lateral segment of left lower lobe,
concern for metastases.
Histopathology:
• Retroperitoneal liposarcoma.
Case 10: 1 years,
Male.
FDG PET CT:
• 5.2 x 4.3 x 3.3 cm large destructive metabolically active mass lesion epicentered in the right maxillary antrum with extension to right nasal cavity and right orbit resulting in proptosis.
Histopathology:
Rhabdomyosarcoma