The Teaching Point

Differentiating malignant transformation of benign tumours continues to be a challenge in clinical practice with radiology playing an important role in answering clinical questions; MRI continues to be the modality of choice for characterizing and delineating the target lesion while CT and PET-CT have been useful for staging disseminated disease, with the latter also helpful in identifying the best location for image guided biopsy. Imaging features of malignant transformation guide radiologists in sieving sinister lesions from benign entities; high risk factors would include: increased largest dimension of mass, increased tumour heterogeneity, peripheral enhancement and perilesional oedema, as in our case study.






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From the manuscript

Malignant transformation in a sciatic plexiform neurofibroma in Neurofibromatosis Type 1 - imaging features that aid diagnosis

Free full text article: Malignant transformation in a sciatic plexiform neurofibroma in Neurofibromatosis Type 1  - imaging features that aid diagnosis

Abstract
A 41-year-old Asian male with NF1 and bilateral sciatic plexiform neurofibromas, presented with unintentional weight loss, increasing size of a left thigh mass associated with increasing pain and radiculopathy. MRI of the left thigh demonstrated imaging features suspicious of malignant transformation. The patient had a new left lung mass, demonstrating avid FDG uptake, raising suspicion for metastasis. Surgical resection of the left thigh mass confirms malignant transformation in a preexisting sciatic plexiform neurofibroma. Diagnosis of malignant transformation in a nerve sheath tumour can be challenging. MRI remains the main preferred imaging modality in the evaluation of these tumours. Imaging features that raise suspicion for malignant transformation are discussed. Although none of these are specific for malignant transformation, studies suggest that the presence of two to four of these features should prompt further investigations.






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1. Malignant peripheral nerve sheath tumour

2. MPNST

3. neurofibrosarcoma

4. neurofibromatosis type 1

5. NF1

6. plexiform neurofibroma

7. malignant transformation

8. MRI

9. CT

10. PET


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