Beckhorn Catherine,  Lee Rachel,  Cao Joseph

Final Pr. ID: Poster #: CR-028

Background: Granular cell tumors (GCT) are rare Schwann cell-derived soft tissue tumors typically presenting as a solitary, painless nodule in adults in the 4th to 6th decades of life, rarely presenting in children. GCT most commonly originate from gastrointestinal mucosa of the tongue or oral cavity, and are 2-3 times more common in women. While generally benign, approximately 2% of cases may be malignant; therefore, GCTs are typically treated with local surgical control.
Case: A 7-year-old male with sickle cell trait presented to clinic for a painless “pea-sized lump” on his penile shaft, which had been present since infancy but had recently grown larger. Ultrasound demonstrated a 1.8 cm lenticular-shaped mass on the dorsal mid shaft of the penis superficial to the fascial borders of the cavernous cavernosum. There was mild internal vascularity, but no invasion past fascial borders, surrounding soft tissue changes. On MRI, the mass was uniformly T1 iso-intense and T2 slightly hyperintense, with slight postcontrast enhancement. The mass was well-circumscribed, wrapped around the corpus cavernosum without invasion of the tunica albuginea, and exhibited uniform restricted diffusion, calcification, or internal fat. No lymph node involvement was noted on imaging. Surgical resection 8 months later noted a 3 cm mass, which now extended into the glans, with pathology consistent with benign GCT, with positive staining for S-100, CD68, SOX10, and calretinin, Ki-67 of 1%, and negative for SM actin. Due to depth of glans penetration, R2 resection was achieved based on the pediatric urologist’s decision to spare the glans, rather than performing a more aggressive distal penectomy. Post-operative MRI 4 months later demonstrated residual tumor with interval reduction in mass size. Additional investigation of the patient’s past medical history revealed that a benign GCT had been removed from the inside of his lip the previous year which helped support the final histopathologic diagnosis. While multifocal GCTs have been described in genetic syndromes, this patient had not undergone genetic testing to date. Read More

Authors:  Beckhorn Catherine , Lee Rachel , Cao Joseph

Keywords:  MRI, Genitourinary, Soft-Tissue Tumors

Eliades Sarah,  Pomeranz Christy,  Baad Michael,  Roytman Michelle,  Kovanlikaya Arzu

Final Pr. ID: Poster #: EDU-056

Ultrasound is typically the first-line imaging modality for the evaluation of superficial soft tissue masses in the pediatric population. While certain superficial soft tissue masses have a classic appearance on ultrasound, others may have a nonspecific appearance and may vary in their sonographic characteristics. This can make a definitive diagnosis and follow-up recommendations difficult, especially for trainees.

We aim to provide a basic overview of some of the common and less common superficial soft tissue masses that may be encountered in pediatric imaging, and introduce a novel, structured algorithmic approach for evaluating these lesions on ultrasound. The algorithm will assist the radiologist in reaching a definitive diagnosis or narrowing the differential such that a helpful recommendation for further workup can be made. For example, the algorithm will include internal vascularity, border distinctness, cystic or solid components, presence or absence of calcifications, and location in the body and within the superficial soft tissue layers. Pictorial examples of each sonographic feature in the algorithm will provide further assistance.

Pathologies will include but not be limited to: pilomatricoma, glanuloma annulare, epidermal inclusion cyst, ganglion cyst, abscess/infection, lipoma, hematoma, lymph nodes, vascular anomalies, and soft tissue sarcomas. When a definitive diagnosis is not achievable, this algorithm will help the radiologist determine the likelihood of benignity, a short differential diagnosis, and a recommendation for any further imaging workup. Read More

Authors:  Eliades Sarah , Pomeranz Christy , Baad Michael , Roytman Michelle , Kovanlikaya Arzu

Keywords:  Soft tissue mass, Ultrasound, Superficial

Golden Eleza,  Simoneaux Stephen,  Dickson Paula

Final Pr. ID: Poster #: CR-049

To describe the radiographic appearance of subclinical calcified brown fat necrosis and to delineate the associated clinical and laboratory findings. While brown fat necrosis has been described in infants with underlying cardiac disease treated with prostaglandins, we emphasize hypotension from cardiac or respiratory arrest as a primary risk factor. Read More

Authors:  Golden Eleza , Simoneaux Stephen , Dickson Paula

Keywords:  fat necrosis, soft tissue calcification, congenital heart disease

Kazelka Maryam,  Shao Lei,  Mcgraw Marty,  Neville Kucera Jennifer

Final Pr. ID: Poster #: CR-016

Spindle cell sarcomas are a rare and aggressive type of soft-tissue sarcoma. Although rhabdomyosarcomas are the most common childhood sarcoma, the spindle cell type is incredibly rare. A 25-year-old healthy G2P1001 female presents at 34 weeks gestational age with fetal growth restriction of a male fetus. Prenatal ultrasound showed a complex vascular mass exophytic to the distal spine, with a presumed diagnosis of sacrococcygeal teratoma (SCT). For further characterization, a fetal MRI was performed at 35 weeks gestation, which showed a solid appearing mass exophytic to the pelvis and involving the proximal thigh. Many features of the tumor were atypical for sacrococcygeal teratoma: the mass being more homogenous than expected, lacking cystic components that would normally been seen in a SCT, and involving the thigh but without definite involvement of the spine. It was also noted that the normal T1 meconium signal in the rectum was displaced posteriorly by the mass. At that time, an alternative differential diagnosis was suggested: sarcoma including fibrosarcoma or rhabdomyosarcoma, myofibroma, or less likely atypical sacrococcygeal teratoma. The baby was born via C-section at 37 weeks and 1 day gestation. A postnatal MRI showed the mass exophytic to the pelvis with some intrapelvic extension via the inguinal canal. Lack of spine involvement was confirmed. Signal characteristics of the tumor were similar to that of skeletal muscle, with a few focal areas of internal hemorrhage. The tumor had mass effect on multiple structures: deviating and tethering of the rectum to the right and stretching it inferiorly; displacing the anus posteriorly; uplifting the bladder; and abutting the base of the penis with no clear fat planes. Surgical resection was performed when the baby was 6 days old. Pathology evaluation revealed a sarcoma that was diffusely infiltrative with NTRK reactivity by immunohistochemistry. Molecular studies by next-generation sequencing reported TPM3-NTRK1 fusion in the tumor. Pathology was most suggestive of a spindle-cell sarcoma. It is important for the pediatric radiologist to be familiar with fetal soft tissue tumors to help facilitate family counseling and delivery planning. The radiologist should understand imaging features that may help distinguish more rare soft tissue tumors from sacrococcygeal teratomas. Although an exact diagnosis may not be possible prenatally, a multidisciplinary approach ensures the best possible patient outcomes. Read More

Authors:  Kazelka Maryam , Shao Lei , Mcgraw Marty , Neville Kucera Jennifer

Keywords:  Sarcomas, Fetal Magnetic Resonance Imaging, Soft Tissue Sarcoma

Ksiazek Kathleen

Final Pr. ID: Poster #: EDU-016 (T)

Medical imaging of the soft tissue of the neck or airway is one of the most common, and sometimes challenging, exams performed at a pediatric hospital. Imaging of the airway can help identify enlarged adenoids, the presence of a foreign body, an abscess, pathology or anatomical abnormality. It is crucial to understand the proper technique, breathing instructions and positioning in order to obtain optimal imaging for correct diagnosis. Different radiographic findings will be presented with examples of incorrect positioning, grid usage, exposure factors, artifacts and ways to improve the image quality. This poster will also provide technologists with tips and recommendations to help them to feel prepared and confident to work with all pediatric patients. Read More

Authors:  Ksiazek Kathleen

Keywords:  Airway, Soft tissue of neck

Chitalkar Sachin,  Shet Narendra

Final Pr. ID: Poster #: EDU-055

To review the characteristic imaging findings of pediatric fibroblastic/myofibroblastic masses to aid in their diagnosis and management.
Soft tissue lesions in pediatric patients encompass a wide variety of pathologies. While a comprehensive review of all possible pathologies is beyond the scope of this poster, we aim to review one particular subset of lesions, fibroblastic lesions (including myofibroblastic neoplasms), in hopes to bring these to mind when evaluating a pediatric soft tissue mass to improve diagnosis and management of these entities.
Soft tissue masses typically present clinically on the basis of history and physical examination. US and MRI are used as first- and second-line imaging modalities, with limited roles for radiographs, CT and FDG-PET. In this poster, we will review the pertinent imaging findings of these neoplasms. Read More

Authors:  Chitalkar Sachin , Shet Narendra

Keywords:  Soft Tissue Mass, Soft-Tissue Tumors, Pediatric Radiology

Sideris Georgios,  Stever Madeline,  Khubchandani Mansha,  Xian Ziyu,  Makris Joseph

Final Pr. ID: Poster #: EDU-062

Soft tissue lesions are very frequently encountered in daily clinical practice. Ultrasonography is typically the first-line modality given its ease of use and low cost. Pediatric radiologists play a crucial role in guiding further management by recommending observation, additional imaging or tissue sampling. However, characterizing lesions solely based on imaging can be challenging, as some cases lack definitive features. This image-rich educational exhibit will showcase both common and rare pediatric soft tissue entities that have been observed at our tertiary medical center from June 2015 to August 2023. Each displayed image will be accompanied by a label indicating whether the diagnosis is confirmed (via biopsy) or highly likely (based on imaging and clinical behavior). Teaching points and differential diagnostic considerations will be provided for each case. The aim of this poster is to highlight the distinguishing features of each entity and to aid in image interpretation. Read More

Authors:  Sideris Georgios , Stever Madeline , Khubchandani Mansha , Xian Ziyu , Makris Joseph

Keywords:  Soft Tissue, Ultrasound

Rossel Natalia,  Pérez-marrero Lizbet,  Whittle Carolina,  Aris Ricardo,  Fuentealba Isabel

Final Pr. ID: Poster #: SCI-025

Soft tissue hemangiomas (STH) are the most common benign vascular tumors in childhood. Its diagnosis is mainly clinical. In some cases, imaging is required, US Doppler choice of preference. Less frequently, it can be complemented with complex studies such as diagnostic angiography, MRI and biopsy, or ultrasonographic follow-up.
This study aims to investigate the characteristics of STH that required imaging follow-up, complex studies or biopsies. Read More

Authors:  Rossel Natalia , Pérez-marrero Lizbet , Whittle Carolina , Aris Ricardo , Fuentealba Isabel

Keywords:  Soft Tissue Hemangioma, Infantile hemangioma, Congenital hemangioma

Hameed Shema,  Lloyd Claire,  Carmichael James,  Navarro Oscar

Final Pr. ID: Poster #: EDU-029

Soft-tissue tumors provide a significant part of a pediatric radiologists’ work. Using the World Health Organization (WHO) soft-tissue tumor classification system, those most relevant to pediatric imaging can be broadly categorized into tumors of adipocytic, fibroblastic/myofibroblastic, so-called fibrohistiocytic, vascular, nerve sheath, uncertain differentiation, smooth and skeletal muscle origin. Ultrasound remains the primary modality of choice as it is quick, provides excellent soft-tissue resolution, allows assessment of vascularity, is cost-effective and does not require sedation in young children. With rapidly advancing technology, exquisite soft-tissue detail can now be achieved, and along with additional knowledge of the natural history and imaging characteristics of soft-tissue tumors in recent years, the diagnostic accuracy of US has significantly increased.
The objectives of this exhibit are to review the sonographic imaging findings of benign and malignant pediatric soft-tissue tumors and present specific features that aid diagnosis using illustrative examples from our institutions. Read More

Authors:  Hameed Shema , Lloyd Claire , Carmichael James , Navarro Oscar

Keywords:  Soft-tissue tumors, Ultrasound, World Health Organization

Smyth Anna,  Aboagye Rosemond,  Lee Anna,  Bray Heather

Final Pr. ID: Poster #: EDU-052

The purpose of this educational exhibit is to illustrate the radiological appearance of various ossified soft tissue lesions. The differential diagnosis is wide, with entities ranging from benign to malignant. Using instructive and interesting cases encountered at our department, this presentation will outline an approach to forming a differential diagnosis. Various teaching points will be highlighted. Pathological correlation will be included where available.

The cases to be presented include:
Myositis ossificans
Fibrodysplasia ossificans progressiva
Tenosynovial osteochondromatosis
Dysplasia Epiphysealis Hemimelica
Pseudohypoparathyroidism - Albright’s hereditary osteodystrophy
Phlebolith in a vascular malformation
Pilomatrixoma
Heterotopic ossification
Synovial Sarcoma

This presentation will highlight the distinguishing imaging characteristics of each entity and help narrow the differential diagnosis for a radiologist when faced with a pediatric ossified soft tissue lesion. Read More

Authors:  Smyth Anna , Aboagye Rosemond , Lee Anna , Bray Heather

Keywords:  Ossified soft tissue