Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9564-9570
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9564
Characteristics of primary giant cell tumor in soft tissue on magnetic resonance imaging: A case report
Jian-Yun Kang, Kai Zhang, Ai-Lian Liu, Hua-Li Wang, Li-Na Zhang, Weiyin Vivian Liu
Jian-Yun Kang, Ai-Lian Liu, Li-Na Zhang, Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Kai Zhang, Department of Radiology, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
Hua-Li Wang, Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Weiyin Vivian Liu, MR Research China, GE Healthcare, Beijing 100176, China
Author contributions: Zhang LN and Wang HL conceived and participated in study design and coordination, and contributed equally to this work; Kang JY and Zhang Kai drafted the manuscript, collected the clinical materials and radiological data, and contributed equally to this work; Wang HL participated in the pathological workup; Liu AL and Liu WV revised the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81502274; National Natural Science Foundation of China (General Program), No. 81771804; and Guiding Plan of Natural Science Foundation in Liaoning, China, No. 2019-ZD-0907.
Informed consent statement: Written informed consent was obtained from the patient for publication of this study and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Na Zhang, MS, Associate Professor, Chief Doctor, Department of Radiology, First Affiliated Hospital of Dalian Medical University, No. 222 Zhong Shan Road, Xigang District, Dalian 116011, Liaoning Province, China. zln201045@163.com
Received: March 13, 2021
Peer-review started: March 13, 2021
First decision: August 18, 2021
Revised: August 20, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: November 6, 2021
Processing time: 230 Days and 7.8 Hours
Abstract
BACKGROUND

Primary soft tissue giant cell tumor (GCT-ST) is rare and has relatively low malignant potential. Most reports are pathological and clinical studies, while imaging studies have only been reported in cases of adjacent bone or with atypical cystic degeneration. With regard to the findings on magnetic resonance imaging (MRI) or ultrasonography, superficial masses can be further identified based on facial edema, skin thickening, skin contact, internal hemorrhage or necrosis and lobulation of the mass. Unlike deep-seated masses, MRI features do not always provide an accurate diagnosis for benign and malignant patients with superficial soft-tissue lesions. Thus, the application of diffusion-weighted imaging (DWI) to evaluate superficial soft tissue tumors is necessary.

CASE SUMMARY

A 36-year-old woman who had a suspected malignant tumor in the upper limb on ultrasound and computed tomography is reported. The signal intensity of the suspected tumor was heterogeneous on plain MRI; nodular and heterogeneous enhancement was observed in the tumor with irregular shapes and blurred margins on dynamic contrast-enhanced MRI. The lesion on DWI was hyperintense with a higher mean apparent diffusion coefficient (ADC) value. Finally, a GCT-ST was confirmed by pathology. This case suggests that GCT-ST should be distinguished as a benign soft tissue mass from giant cell-rich soft tissue neoplasms or malignant tumors.

CONCLUSION

The MRI features of the superficial GCT-ST in the upper limb included heterogeneous signal intensity within the lesion on T2-weighted image (T2WI) and T1-weighted fat-saturation spoiled gradient recalled echo (T1 FSPGR), nodular enhancement with blurred margins, irregular shapes, and a slow-increased enhancement. DWI could be used to differentiate a benign soft tissue mass from a malignant mass by the mean ADC value and provide more radiologic-pathologic information for the diagnosis of GCT-ST. Comprehensive imaging of primary GCT-ST could help complete tumor resection, and in turn likely prolong survival after surgery.

Keywords: Soft tissue giant cell tumor; Magnetic resonance imaging; Diffusion-weighted imaging; Case report

Core Tip: The comprehensive magnetic resonance imaging (MRI) features of primary superficial soft tissue giant cell tumor (GCT-ST) in the upper limb were reported in our case. The manifestations of MRI included heterogeneous signal intensity within the lesion on T2-weighted image and T1-weighted fat-saturation spoiled gradient recalled echo, nodular enhancement with blurred margins, irregular shapes, and a slow-increased enhancement. Diffusion-weighted imaging could be used in the differential diagnosis by the mean apparent diffusion coefficient value and provide more radiologic-pathologic information for the diagnosis of GCT-ST.