What’s the Diagnosis – Case 102
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Findings A soft tissue mass is present with associated bony remodeling of the second toe. On the MRI, there is a high T2 signal, lobulated soft tissue mass that causes indolent erosion of the bone and bony remodeling. On the post contrast imaging, there is enhancement of the periphery as well as of septa in the mass.
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Diagnosis: Soft tissue chondroma Soft tissue masses can either be readily diagnosed such as lipoma or peripheral nerve sheath tumor, completely nonspecific in nature, or may have characteristics suggesting but not definitive for the mass. This mass falls into the latter from an imaging standpoint. Cartilage lesions typically have high T2 or high proton density signal with a lobulated architecture. Cartilage lesions are frequently found in the medullary aspect of the bone as enchondroma which typically does not require contrast for diagnosis. Therefore, the post contrast appearance is not as familiar but this case does show the typical post contrast architecture of a cartilage lesion with peripheral enhancement and enhancement of septa of cartilage cells through the mass. This case also highlights typical features of a soft tissue as compared to a bony mass where the epicenter of the mass is within the soft tissue, there is a bowing or beveling of the cortex toward the medullary aspect of the bone, and an absent periosteal reaction. The indolent remodeling of the bone indicates a long standing process which is most likely benign but could be seen in a low grade malignancy. In this case although a cartilage lesion was prospectively entertained, pain as well as the difficulty in excluding a low grad chondrosarcoma necessitated surgical removal.
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Resources MB Zlatkin, PH Lander, LR Begin, A Hadjipavlou. Soft-tissue chondromas. American Journal of Roentgenology. 1985;144: 1263-1267. 10.2214/ajr.144.6.1263 alaniappan Lakshmanan, Harris Gellman, MD. Medscape. Chondromas. Sept 21, 2015
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