PMC2895297_01
The morphologic appearance of the tumor
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F0001
The tumor was 13 x 18 cm in size; the overlying skin was of normal color, with hemorrhagic ulcerations on it [Figure 1].
The T2-weighted, fat-saturated coronal MR image showed the solid mass with multilobulated, relatively homogenous high-signal-intensity pattern, with focal invasions in the deep muscle planes and cutaneus and subcutaneus tissues
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F0002
MRI was done to evaluate the communications of tumor with neighboring structures and showed a multilobulated, relatively homogenous, high-signal-intensity solid mass with focal invasions at the deltoid muscle and deep extensions into the biceps, brachialis, and triceps muscles inferiorly; there was also infiltration of the cutaneus and subcutaneous tissues on fat-suppression images [Figure 2].
Tail-like projections in fibrosarcoma protuberans in fat- saturated T2-weighted axial MR image. The tumor with its high-signal-intensity pattern shows tail-like deep extensions (arrows) with some indefinite contours
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F0003
To the best of our knowledge, the focal invasions in the deltoid muscle and tail-like projections into dermis are important and new findings in the MR imaging of this tumor [Figure 3].
The mass lesion revealed a low-signal-intensity appearance with a tiny tail-like extension superiorly on T1-weighted images
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F0004
The mass lesion revealed a low-signal-intensity appearance with tiny tail-like extension superiorly on T1-weighted image [Figure 4].
Per-operative tumor mass after resection
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In view of the possibility of peripheral extension of the tumor tissue, a wide resection was planned so as to include more than a 3-cm margin of normal cutaneus tissue, at least 2 cm of the underlying normal tissue of the deltoid muscle, and also approximately 0.5 cm of noninfiltrated superficial layers of the other arm muscles [Figure 5].
Immunohistochemical appearance (x40 100 HE)
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Microscopic examination, which included histopathologic and immunohistochemical analysis with CD-34, confirmed the diagnosis of DFSP [Figure 6].
The clinical appearance of the shoulder of the patient 21 months after the operation
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A physical therapy and rehabilitation program was prescribed, and after 3 months of an intensive exercise program, the performance of the shoulder had improved, with 90  abduction, 70  external rotation, and 25  internal rotation [Figures 7 and 8].
The clinical appearance of patient 24 months after surgery. Open space shoulder activity is shown
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F0008
A physical therapy and rehabilitation program was prescribed, and after 3 months of an intensive exercise program, the performance of the shoulder had improved, with 90  abduction, 70  external rotation, and 25  internal rotation [Figures 7 and 8].