PMC6159117_01
Plain radiographs showing homogenous soft tissue masses over the right ankle (a) and calf (b).
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Plain radiograph (Figure 1) showed two oval well-defined homogenous soft tissue masses in the posterior right calf and at the ankle.
(a) Pre-contrast spin echo axial T1 weighted MR image (TR/TE, 904/16) shows a bulging mass (short arrow) in the subcutaneous tissue over the right ankle which is iso-intense to adjacent muscle (long arrow). (b) Pre- and post- contrast spin echo axial T1 weighted MR images (TR/TE, 904/16) show enhancement of the right posterolateral calf mass (arrow heads). (c) Coronal T2 weighted fat-saturated MR image (TR/TE, 2000/32) shows a bulging mass (short arrow) in the subcutaneous layer of the right calf and right ankle (long arrow) which is hyper-intense to adjacent muscle.
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T2W as well as post contrast axial MRI images were acquired. These show a well-defined oval-shaped mass which is iso-intense on T1W and hyperintense on T2W sequences in the subcutaneous tissue of the right calf, displacing the adjacent muscles anteriorly. This mass measures 8.3 cm by 4.0 cm by 5.3 cm in longitudinal, anteroposterior and transverse dimensions, respectively. (Figure 2) A similar but smaller mass was seen in the subcutaneous tissue in the lateral aspect of the right foot. These masses show marked and bright heterogeneous enhancement after intravenous administration of paramagnetic contrast agent (Gadolinium DTPA).
Histological features of diffuse neurofibroma. Photomicrographs of surgical specimen of diffuse neurofibroma (a, b), showing spindle shaped cells with wavy to comma-shaped nuclei (arrow on photomicrograph) on a fibromyxoid background. (a = H&E x100, b = H&E x400).
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The spindle cells have wavy to curved elongated nuclei with scant eosinophilic cytoplasm. (Figure 3).