Abstract

Amaç: Günlük pratikte karşılaştığımız, yüzeysel yerleşimli, palpabl yumuşak doku kitlelerinin ultrasonografi (US) görüntüleme bulgularını araştırmak amaçlanmıştır. Gereç ve Yöntem: Bölümümüzde Ekim 2012-Mart 2018 tarihleri arasında, palpabl deri altı lezyon nedeniyle US yapılan 92 hasta retrospektif olarak değerlendirildi. Hastane arşiv sisteminden hastaların US raporları, mevcutsa patoloji raporları, klinik ve radyolojik takipleri araştırıldı. Lipom ve basit kistler “kesinlikle benign” olarak kabul edildi. Hipoekoik/heterojen, oval şekilli ve düzgün kenarlı, minimal kanlanma gösteren ya da avasküler solid lezyonlar “olasılıkla benign” olarak sınıflandırıldı. Düzensiz kontürlü ve/veya disorganize kanlanma gösteren, heterojen solid kitleler “şüpheli lezyon” olarak belirlendi. Primer malignitesi olan hastalarda düzensiz kontürlü heterojen kitleler “yüksek olasılıkla metastaz” olarak değerlendirildi. Bulgular: Hastaların %9’unda US ile herhangi bir lezyon saptanmadı. Kırk altı hasta lipom icin tipik US bulgularına sahipti. On altı hastada basit ya da komplike kistik lezyon mevcuttu. On dört hastada “olasılıkla benign” lezyon saptandı ve hepsinde histopatolojik sonuç benigndi. Dört hastada “şüpheli lezyon” vardı ve histopatolojik tanı ikisinde yağ nekrozu, birinde ruptür epidermal inklüzyon kisti ve birinde leiomyosarkom idi. Primer malignitesi olan üç hastada “yüksek olasılıkla metastaz” olarak değerlendirilen yüzeyel lezyonlar vardı ve hepsi patoloji ile doğrulandı. Bir hastada aksesuar meme dokusu saptandı. Sonuç: US yüzeysel kitleleri göstermede, iç yapılarını ortaya koymada ve basit/benign kitleleri tanımada oldukça başarılıdır. İleri inceleme, US bulgularının tanımlayıcı olmadığı ya da şüpheli olduğu lezyonlarda gereklidir. Anahtar Kelimeler: Ultrason, Lipom, Epidermal Kist

Keywords

• Ultrason
• Lipom
• Epidermal Kist

Ultrasound Imaging Findings of Subcutaneous Masses

Abstract

Objectives: We aimed to investigate ultrasonography (US) imaging findings of palpable superficial soft-tissue masses in routine practice. Materials and Methods: We retrospectively investigated 92 patients with palpable subcutaneous masses, who underwent US imaging in our department between October 2012 and March 2018. Patients’ electronic medical records were reviewed for US reports, pathology results if available, and clinical/radiological follow-up. Lipomas and simple cysts were considered as “absolutely benign”. Hypoechoic/heterogenous solid lesions with oval shape and smooth margins, with minimal or no vascularization were determined as “probably benign”. “Indetermined lesions” were defined as heterogeneous masses with irregular margins or disorganized vascularity. Heterogeneous lesions with irregular margins in patients with a primary malignancy were considered as “highly suspicious for metastases”. Results: In 9% of the patients, no lesion was detected on US. Forty-Six patients showed typical US imaging findings of lipoma, 16 lesions were defined as simple or complex cystic masses. Fourteen lesions were classified as “probably benign” on US and all of them were benign on histopathological examination. Four lesions were classified as “indeterminate” on US and histopathological diagnosis was fat necrosis in two lesions, ruptured epidermal inclusion cyst in one lesion, and leiomyosarcoma in one lesion. Three patients with a known primary malignancy had lesions suggesting malignant infiltration, and they were all confirmed on histopathological examination. Accessory breast tissue was detected in one patient presenting with axillary palpable mass. Conclusion: US is useful in demonstrating the presence and the nature of a mass and can diagnose benign incomplex masses. Further investigation should be considered when US findings are inconclusive. Key Words: Ultrasound, Lipoma, Epidermal Cyst

Keywords

• Ultrasound
• Lipoma
• Epidermal Cyst

References

1. 1. Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. Philadelphia: Lippincott Williams & Wilkins; 2006.
2. 2. Beaman FD, Kransdorf MJ, Andrews TR, et al. Superficial soft-tissue masses: analysis, diagnosis, and differential considerations. Radiographics.2007;27:509-523.
3. 3. Nakamura, T, Matsumine A, Matsubara T, et al, The symptom-to-diagnosis delay in soft tissue sarcoma influence the overall survival and the development of distant metastasis. J Surg Oncol. 2011;104:771-775.
4. 4. Lagalla R, Iovane A, Caruso G, et al. Color Doppler ultrasonography of softtissue masses. Acta Radiol. 1998;39:421-426.
5. 5. Milos RI, Moritz T, Bernathova M, et al. Superficial desmoid tumors: MRI and ultrasound imaging characteristics. Eur J Radiol. 2015;84:2194-2201.
6. 6. Yeoh HJ, Kim TY, Ryu JA. The feasibility of shear wave elastography for diagnosing super cial benign soft tissue masses. Ultrasonography. 2019;38:37-43.
7. 7. Vilas-Sueiro A, Alfageme-Roldán F, Nájera P, et al. Our experience with strain elastography in 2 cases of suspected malignant subcutaneous lesions. Actas Dermosifiliogr. 2018;109:274-276.
8. 8. Walker EA, Fenton ME, Salesky JS, et al. Magnetic resonance imaging of benign soft tissue neoplasms in adults. Radiol Clin N Am. 2011;49:1197- 1217.

9. 9. Walker EA, Salesky JS, Fenton ME, et al. Magnetic resonance imaging of malignant soft tissue neoplasms in the adult. Radiol Clin N Am. 2011;49:1219–1234.
10. 10. Huang CC, Ko SF, Huang HY, et al. Epidermal cysts in the superficial soft tissue. Sonographic features with an emphasis on the pseudotestis pattern. J Ultrasound Med. 2011; 30:11–17.
11. 11. Lee DH, Yoon CS, Lim BJ, et al. Ultrasound feature-based diagnostic model focusing on the “submarine sign” for epidermal cysts among superficial soft tissue lesions. Korean J Radiol. 2019;20:1409-1421.
12. 12. An Q, Li JH, Zhang L, et al. Metastatic melanoma misdiagnosed as lipoma manifesting as a subcutaneous soft-tissue mass. Chin Med J. 2019;132:1760- 1762. Blacksin MF, Ha DH, Hameed M, et al. Superficial soft-tissue masses of the extremities. RadioGraphics. 2006;26:1289-1304.