PMC6195923_01
(a,b) Anteroposterior and lateral (frog leg) radiographs of the left femur demonstrate an extraskeletal lesion with dense minerlization, adjacent to the medial aspect of the femur.
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fig1
Anteroposterior (AP) and "frog leg" lateral radiographs of the left lower extremity revealed a dense lesion consistent with dense matrix, adjacent to the medial aspect of the femur (Figure 1a,b).
(a-c) Axial MRI sequences (T
1 fat-saturated, T
2 and T
1 post-contrast fat-saturated) demonstrate a large mass centred in the adductor magnus of the left thigh with internal calcification and peripheral vascularity. The mass demonstrates intermediate T
1 signal and increased heterogeneous T
2 signal (black pepper sign) compared with background muscle. There are no signal abnormalities within the adjacent femur to suggest bony invasion.
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fig2
An MRI of the left lower extremity revealed that the lesion was of extraskeletal origin, arising from the adductor magnus, without any involvement of the femur (Figures 2a,b, 3).
(a,b) Coronal T
1 and sagittal short tau inversion-recovery images demonstrate the superior and inferior margins of the mass, again without evidence of signal abnormality in the adjacent femur to suggest bony invasion.
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fig3
An MRI of the left lower extremity revealed that the lesion was of extraskeletal origin, arising from the adductor magnus, without any involvement of the femur (Figures 2a,b, 3).
An axial CT image of the chest, with intravenous contrast, demonstrates a 2.3-cm right basilar nodule (arrow), confirmed to be a metastatic focus. Multiple additional smaller pulmonary nodules were seen throughout the lung parenchyma (not shown).
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fig4
At 18 months, multiple bilateral non-calcified pulmonary nodules concerning for metastasis were identified (Figure 4).
(a,b) A hypodense pedunculated mass measuring 1.6 cm in greatest dimension, representing adrenal metastasis (arrow).
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fig5
The most prominent pulmonary nodule was present within the posterior right base, measuring 2.3 cm in the greatest dimension and abutting the pleura (Figure 5).