Soft tissue sarcoma. Forty-eight-year-old morbidly obese woman with a painless rapidly enlarging left anterior thigh. (A) Lateral radiograph of the left.

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Presentation transcript:

Soft tissue sarcoma. Forty-eight-year-old morbidly obese woman with a painless rapidly enlarging left anterior thigh. (A) Lateral radiograph of the left femur showing a large anterior thigh soft tissue mass with streaky calcifications in the inferior aspect. There is no gross evidence of bone involvement. (B) Axial T1-weighted fat-saturated postcontrast image through the mid thighs showing a large heterogeneous signal mass centered in the vastus lateralis muscle with irregularly enhancing margins and mixed low signal centrally, findings most consistent with a rapidly growing neoplasm with necrotic center. Again there is no direct evidence of bone involvement. (C) Legs and (D) body summed coronal FDG PET maximum intensity projection (MIP) images from the initial staging study showing intense heterogeneous activity in the large left anterior thigh tumor without evidence of local nodal extension or distant metastatic disease. (E) Fused FDG PET-CT (left) and identical CT only (right) images through the inferior aspect of the large left anterior thigh tumor showing localization of FDG peripherally in the medial and posterior aspect of the tumor and not in the lower density necrotic portions. These images illustrate how staging PET-CT images may also help guide biopsy toward viable tumor cells. The maximum standardized uptake value (SUVmax) within this tumor was approximately 35 g/mL. Note calcifications laterally within the inferior tumor mass that were seen on the radiograph in part (A). (F) Body summed coronal FDG PET MIP images from a restaging study showing intense focal activity overlying the inferior right mediastinum with an SUVmax of 11.2 (green circle), no other abnormal uptake is seen. (G) Fused FDG PET-CT (left) and identical CT only (right) images from the restaging study localizing the FDG uptake seen in part (F) to a large rounded soft tissue mass in the right retrocrural nodal basin most consistent with a distant metastasis. (H) Fused FDG PET-CT (left) and identical CT only (right) images through the region of the surgically removed left anterior thigh tumor (white arrow) showing mild FDG uptake measuring up to 2.2 SUVmax, findings most consistent with postsurgical changes. Source: Musculoskeletal Scintigraphy, Basic Musculoskeletal Imaging Citation: Tehranzadeh J, MD. Basic Musculoskeletal Imaging; 2016 Available at: http://accessphysiotherapy.mhmedical.com/DownloadImage.aspx?image=/data/books/1788/ch20fg9a.png&sec=123934876&BookID=1788&ChapterSecID=123773279&imagename= Accessed: October 21, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved