Superficial soft-tissue masses: analysis, diagnosis, and differential considerations.

A wide variety of superficial soft-tissue masses may be seen in clinical practice, but a systematic approach can help achieve a definitive diagnosis or limit a differential diagnosis. Superficial soft-tissue masses can generally be categorized as mesenchymal tumors, skin appendage lesions, metastatic tumors, other tumors and tumorlike lesions, or inflammatory lesions. With regard to their imaging features, these masses may be further divided into lesions that arise in association with the epidermis or dermis (cutaneous lesions), lesions that arise within the substance of the subcutaneous adipose tissue, or lesions that arise in intimate association with the fascia overlying the muscle. The differential diagnosis may be limited further by considering the age of the patient, anatomic location of the lesion, salient imaging features, and clinical manifestations.

From the archives of the AFIP: imaging of musculoskeletal liposarcoma with radiologic-pathologic correlation.

Liposarcoma is the second most common type of soft-tissue sarcoma, accounting for 10%-35% of these lesions. The World Health Organization has categorized soft-tissue liposarcomas into five distinct histologic subtypes: well differentiated, dedifferentiated, myxoid, pleomorphic, and mixed type. Well-differentiated liposarcomas frequently demonstrate a diagnostic appearance on computed tomographic (CT) or magnetic resonance (MR) images, with a largely lipomatous mass (>75% of the lesion) and nonlipomatous components in thick septa or focal nodules. The CT or MR imaging finding of a nodular dominant focus (>1 cm in size) of nonlipomatous tissue in a well-differentiated liposarcoma suggests dedifferentiated liposarcoma, and biopsy should be directed at the nonadipose component. The high water content of myxoid liposarcoma seen at pathologic analysis and constituting the majority of the lesion is reflected at sonography, CT, and MR imaging. However, the detection of a small amount of adipose tissue in the septa or as small nodular foci superimposed on the background of myxoid tissue allows prospective diagnosis in 78%-95% of myxoid liposarcomas. Pleomorphic liposarcomas are high-grade sarcomatous lesions and typically appear as heterogeneous soft-tissue masses, although small amounts of fat are seen on MR images in 62%-75% of cases, findings that suggest the diagnosis. Mixed-type liposarcomas have features representing a combination of the other subtypes. Primary liposarcoma of bone is exceedingly rare and usually demonstrates aggressive nonspecific features, although fat may be seen. Understanding and recognition of the spectrum of appearances of the various types of musculoskeletal liposarcoma, which reflect their underlying pathologic characteristics, improves radiologic assessment and is vital for optimal patient management.