Semin Musculoskelet Radiol 2005; 09(3): 227-242
DOI: 10.1055/s-2005-921942
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Soft Tissue Masses in the Foot and Ankle: Characteristics on MR Imaging

Klaus Woertler1
  • 1Department of Radiology, Technische Universität München, Munich, Germany
Further Information

Publication History

Publication Date:
25 October 2005 (online)

ABSTRACT

Benign neoplasms and tumor-like lesions constitute the majority of soft tissue masses in the foot and ankle. Therefore, malignant tumors are often unsuspected at this site and misdiagnosed clinically, especially if occurring in young individuals with unspecific or long-standing clinical symptoms. In addition to radiography, MR imaging represents the method of choice in evaluation of foot tumors. Because of their relatively characteristic imaging appearance, in most cases of benign soft tissue lesions of the foot and ankle a specific diagnosis can be suggested. Unfortunately, malignant tumors can also arise with nonaggressive imaging features. Diagnostic errors can be avoided if any soft tissue lesion that cannot be specifically diagnosed is regarded as potentially malignant until proved otherwise. This article reviews the MR appearance of the most common benign and malignant soft tissue masses in the foot and ankle together with their clinical, radiographic, and pathological findings.

REFERENCES

  • 1 Kransdorf M J. Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location.  AJR Am J Roentgenol. 1995;  164 395-402
  • 2 Kransdorf M J. Malignant soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location.  AJR Am J Roentgenol. 1995;  164 129-134
  • 3 Bos G D, Esther R J, Woll T S. Foot tumors: diagnosis and treatment.  J Am Acad Orthop Surg. 2002;  10 259-270
  • 4 Kirby E J, Shereff M J, Lewis M M. Soft-tissue tumors and tumor-like lesions of the foot. An analysis of eighty-three cases.  J Bone Joint Surg Am. 1989;  71 621-626
  • 5 Llauger J, Palmer J, Monill J M, Franquet T, Bagué S, Rosón N. MR imaging of benign soft-tissue masses of the foot and ankle.  Radiographics. 1998;  18 1481-1498
  • 6 Waldt S, Rechl H, Rummeny E J, Woertler K. Imaging of benign and malignant soft tissue masses of the foot.  Eur Radiol. 2003;  13 1125-1136
  • 7 Wetzel L H, Levine E. Soft-tissue tumors of the foot: value of MR imaging for specific diagnosis.  AJR Am J Roentgenol. 1990;  155 1025-1030
  • 8 Sundaram M, Sharafuddin M J. MR imaging of benign soft-tissue masses.  Magn Reson Imaging Clin N Am. 1995;  3 609-627
  • 9 Bakotic B W, Borkowski P. Primary soft-tissue neoplasms of the foot: the clinicopathologic features of 401 cases.  J Foot Ankle Surg. 2001;  40 28-35
  • 10 Zeytoonjian T, Mankin H J, Gebhardt M C, Hornicek F J. Distal lower extremity sarcomas: frequency of occurrence and patient survival rate.  Foot Ankle Int. 2004;  25 325-330
  • 11 Weiss S W, Goldblum J R. Enzinger and Weiss's Soft Tissue Tumors. 4th ed. St. Louis; Mosby 2001
  • 12 Robbin M R, Murphey M D, Temple T, Kransdorf M J, Choi J J. Imaging of musculoskeletal fibromatosis.  Radiographics. 2001;  21 585-600
  • 13 Morrison W B, Schweitzer M E, Wapner K L, Lackman R D. Plantar fibromatosis: a benign neoplasm with a characteristic appearance on MR images.  Radiology. 1994;  193 841-845
  • 14 Vandevenne J E, De Schepper A M, De Beuckeleer L et al.. New concepts in understanding evolution of desmoid tumors: MR imaging of 30 lesions.  Eur Radiol. 1997;  7 1013-1019
  • 15 Feld R, Burk D L, McCue P, Mitchell D G, Lackman R, Rifkin M D. MRI of aggressive fibromatosis: frequent appearance of high signal intensity on T2-weighted images.  Magn Reson Imaging. 1990;  8 583-588
  • 16 Murphey M D, Fairbairn K J, Parman L M, Baxter K G, Parsa M B, Smith W S. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation.  Radiographics. 1995;  15 893-917
  • 17 Cohen E K, Kressel H Y, Perosio T et al.. MR imaging of soft-tissue hemangiomas: correlation with pathologic findings.  AJR Am J Roentgenol. 1988;  150 1079-1081
  • 18 Suh J S, Hwang G, Hahn S B. Soft tissue hemangiomas: MR manifestations in 23 patients.  Skeletal Radiol. 1994;  23 621-625
  • 19 Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma: a clinico-pathologic reappraisal of 562 cases.  Cancer. 1984;  54 126-130
  • 20 Hwang J W, Ahn J M, Kang H S, Suh J S, Kim S M, Seo J W. Vascular leiomyoma of an extremity: MR imaging-pathology correlation.  AJR Am J Roentgenol. 1998;  171 981-984
  • 21 Kinoshita T, Ishii K, Abe Y, Naganuma H. Angiomyoma of the lower extremity: MR findings.  Skeletal Radiol. 1997;  26 443-445
  • 22 Yates B J. Angiomyoma: clinical presentation and surgical management.  Foot Ankle Int. 2001;  22 670-674
  • 23 Kransdorf M J, Bancroft L W, Peterson J J, Murphey M D, Foster W C, Temple H T. Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma.  Radiology. 2002;  224 99-104
  • 24 Ohguri T, Aoki T, Hisaoka M et al.. Differential diagnosis of peripheral lipoma from well-differentiated liposarcoma on MR imaging: is comparison of margins and internal characteristics useful?.  AJR Am J Roentgenol. 2003;  180 1689-1694
  • 25 Galant J, Marti-Bonmati L, Saez F, Soler R, Alcala-Santaella R, Navarro M. The value of fat-suppressed T2 or STIR sequences in distinguishing lipoma from well-differentiated liposarcoma.  Eur Radiol. 2003;  13 337-343
  • 26 Chung E B, Enzinger F M. Chondroma of soft parts.  Cancer. 1978;  41 1414-1424
  • 27 Kransdorf M J, Meis J M. Extraskeletal osseous and cartilaginous tumors of the extremities.  Radiographics. 1993;  13 853-884
  • 28 Zlatkin M B, Lander P H, Hadjipavlou A. Soft-tissue chondromas.  AJR Am J Roentgenol. 1985;  144 1263-1267
  • 29 Woertler K, Blasius S, Brinkschmidt C, Hillmann A, Link T M, Heindel W. Periosteal chondroma: MR characteristics.  J Comput Assist Tomogr. 2001;  25 425-430
  • 30 Horcajadas A B, Lafuente J L, de la Cruz Burgos R et al.. Ultrasound and MR findings in tumor and tumor-like lesions of the fingers.  Eur Radiol. 2003;  13 672-685
  • 31 Jaffe H L, Liechtenstein L, Sutro C J. Pigmented villonodular synovitis, bursitis, tenosynovitis.  Arch Pathol. 1941;  31 731-765
  • 32 Ushijima M, Hashimoto H, Tsuneyoshi M, Enjoji M. Giant cell tumor of the tendon sheath (nodular tenosynovitis): a study of 207 cases to compare the large joint group with the common digit group.  Cancer. 1986;  57 875-884
  • 33 Dorwart R H, Genant H K, Johnston W H, Morris J M. Pigmented villonodular synovitis of synovial joints: clinical, pathologic, and radiologic features.  AJR Am J Roentgenol. 1984;  143 877-885
  • 34 Bravo S M, Winalski C S, Weissmann B N. Pigmented villonodular synovitis.  Radiol Clin North Am. 1996;  34 311-326
  • 35 Hughes T H, Sartoris D J, Schweitzer M E, Resnick D L. Pigmented villonodular synovitis: MR characteristics.  Skeletal Radiol. 1995;  24 7-12
  • 36 De Beuckeleer L, De Schepper A, De Belder F et al.. Magnetic resonance imaging of localized giant cell tumour of the tendon sheath (MRI of localized GCTTS).  Eur Radiol. 1997;  7 198-201
  • 37 Myers B W, Masi A T, Feigenbaum S L. Pigmented villonodular synovitis and tenosynovitis: a clinical epidemiologic study of 166 cases and literature review.  Medicine. 1980;  59 223-238
  • 38 Jelinek J S, Kransdorf M J, Shmookler B M, Aboulafia A A, Malawer M M. Giant cell tumor of the tendon sheath: MR findings in nine cases.  AJR Am J Roentgenol. 1994;  162 919-922
  • 39 Amoroux J. Synovial chondromatosis. In: Forest M Orthopedic Surgical Pathology. Edinburgh; Churchill Livingstone 1997: 693-703
  • 40 Crotty J M, Monu JUV, Pope T L. Synovial osteochondromatosis.  Radiol Clin North Am. 1996;  34 327-342
  • 41 Milgram J W. Synovial osteochondromatosis: a histopathological study of thirty cases.  J Bone Joint Surg Am. 1977;  59 792-801
  • 42 Wittkop B, Davies A M, Mangham D C. Primary synovial osteochondromatosis and synovial chondrosarcoma.  Eur Radiol. 2002;  12 2112-2119
  • 43 Kramer J, Recht M, Deely D M et al.. MR appearance of idiopathic synovial osteochondromatosis.  J Comput Assist Tomogr. 1993;  17 772-776
  • 44 Murphey M D, Smith S W, Smith S E, Kransdorf M J, Temple T. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation.  Radiographics. 1999;  19 1253-1280
  • 45 Zanetti M, Ledermann T, Zollinger H, Hodler J. Efficacy of MR imaging in patients suspected of having Morton's neuroma.  AJR Am J Roentgenol. 1997;  168 529-532
  • 46 Weishaupt D, Treiber K, Kundert H P et al.. Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions.  Radiology. 2003;  226 849-856
  • 47 Zanetti M, Strehle J K, Zollinger H, Hodler J. Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers.  Radiology. 1997;  203 516-520
  • 48 Kliman M E, Freiberg A. Ganglia of the foot and ankle.  Foot Ankle. 1982;  3 45-46
  • 49 Steiner E, Steinbach L S, Schnarkowski P, Tirman PFJ, Genant H K. Ganglia and cysts around joints.  Radiol Clin North Am. 1996;  34 395-425
  • 50 Weishaupt D, Schweitzer M E, Morrison W B, Haims A H, Wapner K, Kahn M. MRI of the foot and ankle: prevalence and distribution of occult and palpable ganglia.  J Magn Reson Imaging. 2001;  14 464-471
  • 51 Scully S P, Temple H T, Harrelson J M. Synovial sarcoma of the foot and ankle.  Clin Orthop. 1999;  364 220-226
  • 52 Morton M J, Berquist T H, McLeod R A, Unni K K, Sim F H. MR imaging of synovial sarcoma.  AJR Am J Roentgenol. 1991;  156 337-340
  • 53 Jones B C, Sundaram M, Kransdorf M J. Synovial sarcoma: MR imaging findings in 34 patients.  AJR Am J Roentgenol. 1993;  161 827-830
  • 54 Blacksin M F, Siegel J R, Benevenia J, Aisner S C. Synovial sarcoma: frequency of nonaggressive MR characteristics.  J Comput Assist Tomogr. 1997;  21 785-789
  • 55 Fletcher C DM, Unni K K, Mertens F. Pathology and genetics of tumours of soft tissue and bone. In: World Health Organization Classification of Tumours Lyon; IARC Press 2002
  • 56 Chung E B, Enzinger F M. Malignant melanoma of soft parts: a reassessment of clear cell sarcoma.  Am J Surg Pathol. 1983;  7 405-413
  • 57 De Beuckeleer L, De Schepper A, Vandevenne J E et al.. MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review.  Skeletal Radiol. 2000;  29 187-195
  • 58 Lewis J J, Leung D, Heslin M, Woodruff J M, Brennan M F. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma.  J Clin Oncol. 1997;  15 646-652
  • 59 Pisters PWT, Leung DHY, Woodruff J, Shi W, Brennan M F. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.  J Clin Oncol. 1996;  14 1679-1689
  • 60 Owens J C, Shiu M H, Smith R, Hajdu S. Soft tissue sarcomas of the hand and foot.  Cancer. 1985;  55 2010-2018
  • 61 Anderson M W, Temple H T, Dussault R G, Kaplan P A. Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors.  AJR Am J Roentgenol. 1999;  173 1663-1671
  • 62 Erickson S J, Rosengarten J L. MR imaging of the forefoot: normal anatomic findings.  AJR Am J Roentgenol. 1993;  160 565-571

Klaus WoertlerM.D. 

Department of Radiology, Technische Universität München

Ismaninger Strasse 22, D-81675 Munich, Germany