46 y/o lady with back pain

 

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Doctor's Information

Name : Seyed Morteza
Family : Bagheri
Affiliation :Radiology Department,Hasheminejad Hospital,IUMS
Academic Degree : Assistant Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mohsen Hasanzadeh

 

Case Section

Neuroradiology

 

Patient's Information

Gender : Female
Age : 46

 

Clinical Summary

46 y/o lady with back pain

 

Imaging Findings

Lobulated enhancing large paraspinal mass (low T1 / high T2 signal, compare to muscles) is seen that extended to spinal canal via neural foramina and produced dumbbell shape mass and foraminal widening (red arrow).there is impression on thecal sac. Multiple soft tissue masses in superficial and deep layer of subcutaneous are noted (blue arrows) that some of them has tubular shape (yellow arrow).There is no evidence of bony destruction. In addition Post surgical findings are seen.

 

Differential Diagnosis

Sarcoma Plexiform schwannoma Lymphoma metastasis

 

Final Diagnosis

Plexiform neurofibroma

 

Discussion (Related Text)

Plexiform neurofibroma is a benign tumor of peripheral nerves (WHO grade I) arising from a proliferation of all neural elements, pathognomonic of neurofibromatosis type 1 (NF1). It involves single or multiple nerve fascicles that arises from major nerve branches. Clinical presentation Clinically, it presents as a subcutaneous mass which feels like a "bag of worms". Most of the time, it is a superficial cutaneous / subcutaneous lesion, but it can occur almost anywhere in the body. Symptoms may be related to local mass effect. It is found in approximately 30 % of patients with neurofibromatosis type 1. There is a risk of malignant transformation in 5 - 10 % of cases. Radiographic features CT Non specific infiltrative subcutaneous lesion. MRI Reported signal characteristics include • T1: hypo intense • T2 : hyper intense +/- hypo intense central focus (target sign) • T1 C+ : mild enhancement

 

References

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