47-year-old female with history of enough, enlarging mass at left inguinal regions with increasing SUV uptake on PET scan, evaluate for MPNST. Again seen are postsurgical changes of a left lower extremity amputation with hip disarticulation. Associated fatty muscle atrophy of the left musculature.Again seen are innumerable cutaneous lesions the multiple masses within the pelvis compatible with neurofibromas. Previous reference right inguinal lesion currently measures 4.6 x 3.7 x 7.3 cm (series 7 image 20, series 5 image knee), previously measuring 3.9 x 3.0 x 5.8 cm. This lesion continues to demonstrate peripheral enhancement suggestive of internal necrosis. Previous reference left psoas muscle lesion measures 4.2 x 4.0 cm (series 7 image 9), previously 4.1 by 4.2 cm.Previous reference left posterior pelvic lesion measures 3.9 cm (series 7 image 24), previously 4.2 cm, although grossly appears unchanged.Neurofibroma within the left psoas muscle is not significantly changed measuring 4.1 x 4.2 cm (series 501 Image 38), previously 4.3 x 4.1 cm. Neurofibroma within the posterior left pelvis exerting mass effect on the uterus has not significantly changed measuring 4.2 cm (series 501 image 21), previously 4.3 cm.Soft tissue mass in the fundus of the uterus has slowly been enlarging and demonstrates avid enhancement post gadolinium. For reference, this lesion measures 7.6 x 5.8 cm (series 1 image 20). Additional heterogeneous and nodular myometrium compatible with leiomyomas again noted.Sacral dural ectasia and scalloping of the posterior aspect of the vertebral bodies appear similar to prior.
1.Continued interval increase in right inguinal neurofibroma with internal necrosis, which was markedly hypermetabolic on recent PET, suspicious for malignant peripheral nerve sheath tumor. Additional neurofibromas appear stable.2.Soft tissue mass at the fundus of the uterus has slowly been growing and demonstrates avid enhancement. Differential diagnosis includes leiomyoma/sarcoma or plexiform neurofibroma.