title: MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review.
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).
  
  
  METHODS
  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.
authors.affiliation: Department of Radiology, University Hospital Antwerp (University of Antwerp), Edegem, Belgium.
authors.forename: L H
authors.initials: LH
authors.lastname: De Beuckeleer
authors.forename: A M
authors.initials: AM
authors.lastname: De Schepper
authors.forename: J E
authors.initials: JE
authors.lastname: Vandevenne
authors.forename: J L
authors.initials: JL
authors.lastname: Bloem
authors.forename: A M
authors.initials: AM
authors.lastname: Davies
authors.forename: M
authors.initials: M
authors.lastname: Oudkerk
authors.forename: E
authors.initials: E
authors.lastname: Hauben
authors.forename: E
authors.initials: E
authors.lastname: Van Marck
authors.forename: J
authors.initials: J
authors.lastname: Somville
authors.forename: D
authors.initials: D
authors.lastname: Vanel
authors.forename: L S
authors.initials: LS
authors.lastname: Steinbach
authors.forename: J M
authors.initials: JM
authors.lastname: Guinebretière
authors.forename: P C
authors.initials: PC
authors.lastname: Hogendoorn
authors.forename: W J
authors.initials: WJ
authors.lastname: Mooi
authors.forename: K
authors.initials: K
authors.lastname: Verstraete
authors.forename: C
authors.initials: C
authors.lastname: Zaloudek
authors.forename: H
authors.initials: H
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018227:Sarcoma, Clear Cell / Q000473:pathology*; D012983:Soft Tissue Neoplasms / Q000473:pathology*