Matteo Battista, TSRM

 An 18-year-old male patient with no apparent trauma presents with the appearance of swelling on the side of the thigh region.

The ultrasound exam showed solid formation, slightly uneven but regular margins of about 5 cm below the subcutaneous adipose tissue, with small liquid water on the medial margin of the lesion. On surgical indication, runs an MRI without contrast medium.

 MRI SE T1 Cor
The survey is integrated with MRI CT examination

MRI examination documents the presence of a liquid collection saccata about 5 x 1, 5 x 9 cm inside which is evident with training of approximately 5 cm with morphology and signal refer to adipose tissue. The formation is removed surgically.



 Fibrolipoma with widespread phenomena of liponecrosi and with distinct angectasici and fibroplastici phenomena.



 Soft tissue tumors are derived predominantly from primitive mesenchyme. Probably the most common mesenchymal tumor is lipoma, a benign tumor composed of mature adipose tissue. Patients with a soft tissue lipoma typically present in middle age (fifth and sixth decades).

A soft tissue lipoma is categorized by anatomic location as either superficial (cutaneous) or deep. The superficial lipoma occurs more commonly and is more sharply circumscribed and smaller in size than its deep-seated counterpart. A superficial (subcutaneous) lipoma may be inapparent, blending in with the adjacent subcutaneous fat on MRI. Unless a marker is placed over the mass before imaging, it may appear only as a thickening of the subcutaneous fat.

The pathogenesis of lipoma is unknown, although it is thought to represent a true mesenchymal neoplasm. It is usually a solitary lesion, although a small percentage of patients (5 percent to 7 percent) demonstrate multiple tumors, which can vary in number from a few to several hundred.

lnterestingly, the fat within the lipoma is unavailable for systemic metabolism and, paradoxically, may actually increase in size during starvation.

The lipoma is well characterized on MRI, with the lesion having an appearance identical to that of subcutaneous fat on all pulse sequences, without discernible enhancement after the administration of intravenous gadolinium.

Lipomas occasionally contain other mesenchymal elements. The most common of these is fibrous connective tissue, which may be in the configuration of septa and therefore appear as linear densities on CT or linear areas of decreased signal on MRI, regardless of pulse sequence. When significant fibrous tissue is present, these lesions may be termed fibrolipoma.

A few cases of malignant transformation of lipoma have been reported, but these may represent cases where the subtle histologic features of malignancy were initially overlooked.



Matteo Battista, TSRM
Graduate Radiology Technologist
San Marco in Lamis, Italy 

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Fibrolipoma 

 A 15-year-old male patient, suffering from gonalgia without apparent trauma, receives an X-ray of his left knee.

X-ray examination shows lithic lesion to the map, eccentric, with localized sclerotics margins at the level of the proximal tibia metaphysis sx.

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Fig. 3 TC soft window

CT examination confirms, in the medial, osteolitica lesion that presents solid formation of calcium type inside, bounded anteriorly and to the sides by sclerotic border, while regular later determines broad erosion of cortical.

Fig. 4 FSE T1 MRI image ax
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Fig. 4 FSE T2 MRI image ax

The MRI has documented decreased signal intensity on T1 and T2 sequences.

 Fibrous cortical lesions and the fibroids do not ossificanti are quite common and fibrous lesions are observed predominantly in children and adolescents. More common in boys than in girls, have a predilection for long bones, femur and tibia. These lesions are not true neoplasms and are considered by many researchers an evolutionary flaw. Most of these lesions disappear spontaneously, but a small portion of them may continue to increase; When they go in the medullary portion of a bone, they are called fibroma non ossificans. The term "fibroxantoma" is preferred by authors in that better reflects the underlying anatomic-pathologic lesion, which is made up of fusiform fibroblasts, scattered giant cells and frothy (xantoma) cells.

X-ray examination of fibroxantoma is potentially pathognomonic since that process looks like lithic lesion to map, with festoons sclerotics edges; the TC may prove best thinning or interruption of cortical and medullary involvement and can delineate more precisely early pathological fracture. HU values to the fibroid is not ossificans are higher than normal bone marrow.

Are occasional findings examining MRI showing intensity signal from intermediate to low both in T1 weighted sequences that in T2. Most injuries undergo a spontaneous involution (maturation) through remodeling or sclerosis. Some larger lesions may be complicated by pathological fractures. So if one of them is voluminous and occupies 50 percent or more of the medullary cavity, curettage with bone grafting is the treatment of choice.

Matteo Battista, TSRM
Graduate Radiology Technologist
San Marco in Lamis, Italy

A 15-year-old male patient, suffering from gonalgia without apparent trauma, receives an X-ray of his left knee.

Author | Matteo Battista, TSRM

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