Skeletal Radiology

, Volume 29, Issue 4, pp 187–195

MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review

  • L. H. De Beuckeleer
  • A. M. De Schepper
  • J. E. Vandevenne
  • J. L. Bloem
  • A. M. Davies
  • M. Oudkerk
  • E. Hauben
  • E. Van Marck
  • J. Somville
  • D. Vanel
  • L. S. Steinbach
  • J. M. Guinebretière
  • P. C. W. Hogendoorn
  • W. J. Mooi
  • K. Verstraete
  • C. Zaloudek
  • H. Jones
Article

Abstract 

Objective. To evaluate MR imaging and pathology findings in order to define the characteristic features of clear cell sarcoma of the soft tissues (malignant melanoma of the soft parts).

Design and patients. MR examinations of 21 patients with histologically proven clear cell sarcoma of the musculoskeletal system were retrospectively reviewed and assessed for shape, homogeneity, delineation, signal intensities on T1- and T2-weighted images, contrast enhancement, relationship with adjacent fascia or tendon, secondary bone involvement, and intratumoral necrosis. In 19 cases the pathology findings were available for review and for a comparative MR-pathology study.

Results. On T1-weighted images, lesions were isointense (n=3), hypointense (n=7) or slightly hyperintense to muscle (n=11). Immunohistochemical examination was performed in 17 patients. All 17 specimens showed positivity for HMB-45 antibody. In nine of 11 lesions with slightly increased signal intensity on T1-weighted images, a correlative MR imaging-pathology study was possible. All nine were positive to HMB-45 antibody.

Conclusions. Clear cell sarcoma of the musculoskeletal system often has a benign-looking appearance on MR images. In up to 52% of patients, this lesion with melanocytic differentiation has slightly increased signal intensity on T1-weighted images compared with muscle. As the presence of this relative higher signal intensity on T1-weighted images is rather specific for tumors displaying melanocytic differentiation, radiologists should familiarize themselves with this rare entity and include it in their differential diagnosis when confronted with a well-defined, homogeneous, strongly enhancing mass with slightly higher signal intensity compared with muscle on native T1-weighted images.

Key words Clear cell sarcoma Malignant melanoma of soft parts MRI Magnetic resonance Neoplasm 

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Copyright information

© International Skeletal Society 2000

Authors and Affiliations

  • L. H. De Beuckeleer
    • 1
  • A. M. De Schepper
    • 1
  • J. E. Vandevenne
    • 1
  • J. L. Bloem
    • 2
  • A. M. Davies
    • 3
  • M. Oudkerk
    • 4
  • E. Hauben
    • 5
  • E. Van Marck
    • 5
  • J. Somville
    • 6
  • D. Vanel
    • 7
  • L. S. Steinbach
    • 8
  • J. M. Guinebretière
    • 9
  • P. C. W. Hogendoorn
    • 10
  • W. J. Mooi
    • 11
  • K. Verstraete
    • 12
  • C. Zaloudek
    • 13
  • H. Jones
    • 14
  1. 1.Department of Radiology, University Hospital Antwerp (University of Antwerp), Wilrijkstraat 10, 2650 Edegem, BelgiumBE
  2. 2.Department of Radiology, Leiden University Medical Center, Leiden, The NetherlandsNL
  3. 3.MRI Center, Royal Orthopaedic Hospital, Birmingham, UKGB
  4. 4.Department of Radiology, Daniel Den Hoed Kliniek (Academisch Ziekenhuis Rotterdam), Rotterdam, The NetherlandsNL
  5. 5.Department of Pathology, University Hospital Antwerp (University of Antwerp), Edegem, BelgiumBE
  6. 6.Department of Orthopaedic Surgery, University Hospital Antwerp (University of Antwerp), Edegem, BelgiumBE
  7. 7.Department of Radiology, Institut Gustave-Roussy, Villejuif, FranceFR
  8. 8.Department of Radiology, University of California San Francisco (UCSF), San Francisco, California, USAUS
  9. 9.Department of Pathology, Institut Gustave-Roussy, Villejuif, FranceFR
  10. 10.Department of Pathology, Leiden University Medical Center, Leiden, The NetherlandsNL
  11. 11.Institute of Pathology, Erasmus University Rotterdam, Rotterdam, The NetherlandsNL
  12. 12.Department of Radiology, University Hospital Ghent, Ghent, BelgiumBE
  13. 13.Department of Pathology, University of California San Francisco (UCSF), San Francisco, California, USAUS
  14. 14.Department of Radiology, Stanford University, Stanford, California, USAUS

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