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Background: Myxofibrosarcoma is a myxoid soft tissue sarcoma showing T2 high intensity on magnetic resonance imaging. However, myxofibrosarcoma is a heterogeneous sarcoma with both myxoid and cellular portions. Magnetic resonance imaging findings were obtained MRI findings for comparison with histological and Ki-67 immunohistochemical features, in different portions of one myxofibrosarcoma. Case presentation: Magnetic resonance imaging observations were compared with gross pathological and microscopic findings of a myxofibrosarcoma from a 50-year-old Japanese female. The Ki-67 labeling indices of different portions of the tumor, that is, the myxoid, cellular, and histologically confirmed infiltrative margin portions (pathological tail sign), were compared. The T2 low intensity area was more cellular than the T2 high intensity area, while the cellular portion had a significantly higher Ki-67 index than the myxoid portion (p = 0.0313). The portions with the pathological tail sign had a significantly higher Ki-67 labeling index than those without this sign (p = 0.0313). Conclusions: More cellular portions of a myxofibrosarcoma correspond to more areas of the tumor showing aggressive features. Furthermore, our data also support the hypothesis of high aggressiveness being associated with the pathological tail sign in myxofibrosarcoma. To our knowledge, this is the first case report to describe comparisons among the imaging findings, histological features, and Ki-67 immunohistochemistry results for different portions of one myxofibrosarcoma. [ABSTRACT FROM AUTHOR]

Myxofibrosarcoma also known as myxoid malignant fibrous histiocytoma is a rare soft tissue sarcoma that has a predilection for the elderly (beyond the 6th decade) We report a case of a 64 years old patient that presented gradual appearance of huge tumor on her left buttock. Radiologic examination (MRI) concluded to MFS. There was no evidence of systemic involvement. The patient was directed in an oncology center, where the diagnostis of MFS was confirmed through surgical biopsy. MFS is one of the most frequent sarcoma of soft tissue that occurs in elderly patients. This is an infiltrant tumor that is extending through muscular fascia. MRI is the gold standard in characterisation; it makes the positive diagnosis of MFS thanks to the myxoid signal, triple signal and the tail sign that is corresponding to the extension of the tumor into the muscular fascia and peri nervous spaces. Cross-sectionnal imaging in particular MRI plays a key role in the positive diagnosis of soft tissue tumors. It makes possible to approach with great precision the exact nature of the tumor thanks to specific radiological semiology without however claiming to replace histology. [ABSTRACT FROM AUTHOR]

Abstract Background Myxofibrosarcoma is a myxoid soft tissue sarcoma showing T2 high intensity on magnetic resonance imaging. However, myxofibrosarcoma is a heterogeneous sarcoma with both myxoid and cellular portions. Magnetic resonance imaging findings were obtained MRI findings for comparison with histological and Ki-67 immunohistochemical features, in different portions of one myxofibrosarcoma. Case presentation Magnetic resonance imaging observations were compared with gross pathological and microscopic findings of a myxofibrosarcoma from a 50-year-old Japanese female. The Ki-67 labeling indices of different portions of the tumor, that is, the myxoid, cellular, and histologically confirmed infiltrative margin portions (pathological tail sign), were compared. The T2 low intensity area was more cellular than the T2 high intensity area, while the cellular portion had a significantly higher Ki-67 index than the myxoid portion (p = 0.0313). The portions with the pathological tail sign had a significantly higher Ki-67 labeling index than those without this sign (p = 0.0313). Conclusions More cellular portions of a myxofibrosarcoma correspond to more areas of the tumor showing aggressive features. Furthermore, our data also support the hypothesis of high aggressiveness being associated with the pathological tail sign in myxofibrosarcoma. To our knowledge, this is the first case report to describe comparisons among the imaging findings, histological features, and Ki-67 immunohistochemistry results for different portions of one myxofibrosarcoma.

Simple Summary: Myxofibrosarcomas (MFS) are malignant soft tissue tumors, frequently located in the extremities. Owing to the infiltrative growth pattern of MFS, neoadjuvant radiotherapy (nRT) is commonly used before surgery to improve local control. Nevertheless, high local recurrence rates are typical in MFS. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients. The presence of a vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was prognostic for both worse disease-free survival (DFS) and overall survival. Additionally, the presence of an infiltrative pattern, referred to as a tail sign, was prognostic for worse DFS. These MRI characteristics could support the identification of patients at risk for poor clinical outcomes after nRT. To improve local control, neoadjuvant radiotherapy (nRT) followed by surgery is the standard of care in myxofibrosarcoma (MFS) because of its infiltrative growth pattern. Nevertheless, local recurrence rates are high. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study thus investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients, as well as their association with disease-free survival (DFS) and overall survival (OS). A vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was observed in 12 patients (30.0%) pre-nRT and remained present post-nRT in all cases. Patients with a vascular pedicle had worse DFS (HR 5.85; 95% CI 1.56–21.90; p = 0.009) and OS (HR 9.58; 95% CI 1.91–48.00; p = 0.006). An infiltrative growth pattern, referred to as a tail sign, was observed in 22 patients (55.0%) pre-nRT and in 19 patients (47.5%) post-nRT, and was associated with worse DFS post-nRT (HR 6.99; 95% CI 1.39–35.35; p = 0.019). The percentage of tumor necrosis estimated by MRI was increased post-nRT, but was not associated with survival outcomes. The presence of a tail sign or vascular pedicle on MRI could support the identification of patients at risk for poor clinical outcomes after nRT. [ABSTRACT FROM AUTHOR]

Objectives: Plunging (or diving) ranulas are extravasation pseudocysts arising from the sublingual gland that present as soft submandibular swelling. The "tail sign" has been widely reported as pathognomonic for their diagnosis. It is described as a smooth tapering comet‐shaped unilocular fluid mass with its "tail" in the collapsed sublingual space (SLS) and its "head" in the posterior submandibular space. This sign is based on the premise that extravasated saliva from the sublingual gland in the SLS escapes and plunges, over the posterior edge of the mylohyoid muscle into the submandibular space. Therefore, some fluid must be present in the posterior SLS in almost all patients with plunging ranulas. This study aimed to determine the frequency of fluid seen with ultrasound (US) in the posterior SLS to corroborate the tail sign. Methods: A total of 126 consecutive cases of surgically proven plunging ranulas were investigated with US over 13 years. The findings were reviewed retrospectively for the prevalence of fluid in the posterior SLS. Results: Thirteen patients (10.3%) showed SLS fluid on US images. Most showed fluid extension through a mylohyoid dehiscence. Only 2 patients (1.6%) showed fluid within the posterior SLS, and 1 patient alone in this entire study showed all of the components of the classically described tail sign. Conclusions: This largest ever radiologic study showed low prevalence of the tail sign in 2 of 126 patients. A mylohyoid dehiscence was the more common route for extravasation. Absence of the tail sign does not exclude the diagnosis of a plunging ranula. [ABSTRACT FROM AUTHOR]

Background & Aim: Various landmarks are discussed to find the facial nerve during parotid surgery. The surgeon should use existing landmarks for a safe surgical use. To evaluate two new landmarks in parotid surgery, this study was done. Methods & Materials/Patients: This cross-sectional study was conducted on 43 patients with parotid masses, whom were referred to Alzahra and Kashani tertiary hospitals in 2013. In a parotid surgery, the greater auricular nerve was detected; then the greater auricular nerve and facial nerve diameter were measured by the compass with precision of 0.1 millimeter and recorded. After facial nerve exploration, if the other landmarks of vascular and tail signs are detected, they are recorded in the files. Results: This study contained 43 patients, 22 men and 21 women. There were 21 (48.8%) masses in deep lobes and others on superficial lobes. In 36 cases (83.7%), vascular signs were observed. In 23 cases (53.5%), tail signs were found. The diameter of facial nerve was 2.647(±4641) mm (minimum: 2 mm and maximum: 4 mm). The diameter of greater auricular nerve was 2.691(±4545) mm (minimum: 2 mm and maximum: 4 mm). By paired T-test, there was no significant difference between the diameter of facial and greater auricular nerves. Of all cases, 76.7% had differences less than 0.5 mm. Conclusion: This study showed that greater auricular nerve can be used as a proper graft for facial nerve, and we can use “vascular sign” as a good indicator of facial nerve.

Schwannoma of the neck is a relatively uncommon tumor. Schwannoma present as insidious, slow-growing, painless masses, characteristics that often lead to an incorrect diagnosis. Cystic schanommas among schanommas are a rare entity. This is a case report of a cystic schwannoma presenting as the cystic lesion in the neck. We report the computed tomography (CT) findings in a 40-year-old female patient presented with a lateral neck mass histologically shown to be a schwannoma, but having certain radiographic features (like tail sign) commonly considered pathognomonic for a type III second branchial cleft cyst (BCC). It is very necessary to differentiate cystic schwannoma from other cystic lesions preoperatively. CT may misguide us for a benign cystic lesion like second BCC. Contrast magnetic resonance imaging and ultrasound findings are very much helpful in differentiation of cystic schwannoma from other cystic lesions of the neck.

A case of chronic, recurrent and asymptomatic facial swelling in a young male is presented. Swelling extended from lower midface to upper lateral neck and right commissure to anterior massetric border. History, clinical signs and symptoms and examination pointed towards the benign nature of the swelling. Fine-needle aspiration cytology tapered the diagnostic possibilities to a salivary cyst or pseudocyst. Ultrasonography identified the lesion to contain echogenic fluid with irregular borders. "Tail sign" was absent on contrast magnetic resonance imaging, excluding the involvement of the sublingual gland. Surgical excision of the lesion was done along with submandibular gland as both were in continuity via a bottle-neck tract. Final histopathological diagnosis was that of the submandibular gland extravasation phenomenon. As per the best of our knowledge, it is the first case report of a submandibular gland extravasation causing swelling in a retrograde direction onto the face. [ABSTRACT FROM AUTHOR]

Schwannoma of the neck is a relatively uncommon tumor. Schwannoma present as insidious, slow-growing, painless masses, characteristics that often lead to an incorrect diagnosis. Cystic schanommas among schanommas are a rare entity. This is a case report of a cystic schwannoma presenting as the cystic lesion in the neck. We report the computed tomography (CT) findings in a 40-year-old female patient presented with a lateral neck mass histologically shown to be a schwannoma, but having certain radiographic features (like tail sign) commonly considered pathognomonic for a type III second branchial cleft cyst (BCC). It is very necessary to differentiate cystic schwannoma from other cystic lesions preoperatively. CT may misguide us for a benign cystic lesion like second BCC. Contrast magnetic resonance imaging and ultrasound findings are very much helpful in differentiation of cystic schwannoma from other cystic lesions of the neck. [ABSTRACT FROM AUTHOR]

Background: In patients with soft-tissue sarcomas of the extremities, the treatment decision is currently regularly based on tumor grading and size. The imaging-based analysis may pose an alternative way to stratify patients' risk. In this work, we compared the value of MRI-based radiomics with expert-derived semantic imaging features for the prediction of overall survival (OS)., Methods: Fat-saturated T2-weighted sequences (T2FS) and contrast-enhanced T1-weighted fat-saturated (T1FSGd) sequences were collected from two independent retrospective cohorts (training: 108 patients; testing: 71 patients). After preprocessing, 105 radiomic features were extracted. Semantic imaging features were determined by three independent radiologists. Three machine learning techniques (elastic net regression (ENR), least absolute shrinkage and selection operator, and random survival forest) were compared to predict OS., Results: ENR models achieved the best predictive performance. Histologies and clinical staging differed significantly between both cohorts. The semantic prognostic model achieved a predictive performance with a C-index of 0.58 within the test set. This was worse compared to a clinical staging system (C-index: 0.61) and the radiomic models (C-indices: T1FSGd: 0.64, T2FS: 0.63). Both radiomic models achieved significant patient stratification., Conclusions: T2FS and T1FSGd-based radiomic models outperformed semantic imaging features for prognostic assessment.