Brief report
Granular cell tumor of soft tissues: MR findings
Tumor de células granulares de partes blandas: hallazgos en resonancia magnética
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Secuencia coronal potenciada en T1 (a) donde observamos el TCGr (flecha) en el tejido subcutáneo del glúteo derecho, de contornos espiculados, siendo isointenso respecto al músculo también en la secuencia axial T2 (b). En la secuencia T1FS tras la administración de gadolinio (c) vemos una captación difusa. Con la imagen de fusión T2/DWI (d) y los valores ADC (e) observamos la restricción de predominio difuso con ADC de 0,624<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">−</span><span class="elsevierStyleSup">3</span>. En el estudio histológico (f) observamos tejido conectivo que muestra entre las fibras de colágeno agregados de células de citoplasma poligonal granular eosinófilo y núcleos ovoides de pequeño tamaño isomorfos. Se apreció positividad para la proteína S100 (g).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Iglesias-Hidalgo, A. Lopez-Maseda, L. Zaldumbide-Dueñas, B. 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The content is highly heterogeneous, with a hyperintense component (*) on the T1-weighted sequences. C) After intravenous contrast administration, central filiform enhancement is seen (→), with no peripheral or nodular enhancement.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Serra del Carpio, M. Tapia Viñé, N. Torena, D. Bernabeu Taboada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Serra del Carpio" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Tapia Viñé" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Torena" ] 3 => array:2 [ "nombre" => "D." 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Iglesias-Hidalgo, A. Lopez-Maseda, L. Zaldumbide-Dueñas, B. Canteli-Padilla" "autores" => array:4 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Iglesias-Hidalgo" "email" => array:1 [ 0 => "gotzon.iglesiashidalgo@osakidetza.eus" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Lopez-Maseda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Zaldumbide-Dueñas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "B." "apellidos" => "Canteli-Padilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor de células granulares de partes blandas: hallazgos en resonancia magnética" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2383 "Ancho" => 3175 "Tamanyo" => 524914 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 2. Axial T1-weighted sequence (a) showing the GrCT (arrow) in the muscle belly of the flexor carpi radialis, which is hypointense to the muscle with a thin hyperintense halo, also observed on the T2-weighted sequence (b). Fusion of T2-weighted and DWI imaging (c) and ADC values (d) we observed predominantly peripheral restriction with ADC of 0.525 × 10<span class="elsevierStyleSup">−3</span>. After gadolinium administration, we observed predominantly peripheral enhancement in axial (e) and coronal (f) T1-weighted fat saturated (T1FS) sequences; in the latter coronal plane, the characteristic ‘stripe sign’ (arrowheads) can be seen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Granular cell tumours (GrCTs) are histologically unique neoplasms that often manifest as painless solitary nodules located in the dermis or submucosal tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They were first called granular cell myoblastomas, until Fisher and Wechsler demonstrated that the tumours derive from Schwann cells.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The tongue is the most frequently reported site, but they have also been described on the chest wall, breast, back and extremities. Most lesions are benign and fewer than 50 cases of malignancy have been reported.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this article we analyse the MRI-specific radiological features of this type of tumour and review the available literature.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical cases</span><p id="par0010" class="elsevierStylePara elsevierViewall">The study was approved by our hospital's ethics committee.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a retrospective review of cases of histologically confirmed benign soft tissue GrCTs with previous magnetic resonance imaging (MRI). The study group comprised five women aged between 23 and 67 years (mean age, 54 years) who presented with painless, progressively growing tumours. Analysis of the MR images was performed by two musculoskeletal radiologists in consensus. They analysed the following features: location (trunk/extremities), origin (subcutaneous/intramuscular), size (longest axis, in millimetres), margins (well-defined/spiculated), T1- and T2 weighted signal, diffusion restriction (peripheral/diffuse) and apparent diffusion coefficient (ADC) value, placing a region of interest (ROI) in the appropriate area. After gadolinium administration, the type of uptake was assessed (no uptake/homogeneous uptake/heterogeneous uptake/peripheral uptake).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The images were acquired using a 1.5 T magnetic field MRI machine (Phillips Achieva). Specific coils were used in each case. The sequences used on all four patients were axial T1-weighted  (TR = 500/TE = 17), axial T2-weighted  (TR = 5. 266/TE = 100), axial DWI (b-value = 0/150/800) and gadolium-enhanced T1-weighted sequences with fat saturation (Dotarem 0.5 mmol/mL with a power injector).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The findings are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Three of the lesions were located in the subcutaneous fatty tissue of the trunk (patients 1, 4 and 5). The other two lesions were intramuscular in the extremities: the wrist and thigh (patients 2 and 3, respectively). The maximum size was 52 mm, with a mean of 36 mm. The subcutaneous lesions had spiculated margins, while the intramuscular lesions had well-defined margins. With respect to the T1-weighted signal, the lesions in the subcutaneous tissue were isointense to the muscle and the intramuscular lesions were hypointense to the muscle. Of the latter, the lesion located on the wrist had a hyperintense peripheral halo (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). As for the T2-weighted signal, all five lesions were isointense to the muscle, and the intramuscular lesion located at the wrist also showed a hyperintense halo (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). In the diffusion-weighted sequence, a predominantly peripheral restriction was evident in three of the five cases, and in the other two cases the diffusion restriction was diffuse (patients 4 and 5); the ADC map revealed low values in all five cases, with an average of 0.758 × 10<span class="elsevierStyleSup">−3</span> mm<span class="elsevierStyleSup">2</span>/s. After contrast administration, three cases showed predominantly peripheral uptake and in two cases the uptake was homogeneous (patients 4 and 5). The diagnosis was confirmed by histological examination, with a positive S100 marker in all cases (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">GrCTs are rare, accounting for 0.5% of soft tissue tumours.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Abrikossoff first described them in 1926,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> labelling them as myoblastomas, in the belief that they originated from muscle. Fisher and Wechsler later demonstrated that the tumour originated from Schwann cells,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and this hypothesis was confirmed by immunohistochemical analyses which were positive for S100 protein.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This type of tumour generally affects women between 40–60 years old, so our results are consistent with the literature.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Most cases reported involve the tongue, head and neck, but there are also reports of cases in the digestive tract, breast and extremities. They are usually benign, although they may be locally infiltrative and recur. Up to two percent may be malignant. These typically involve those larger than 5 cm, intramuscular, located on the extremities or those that exhibit infiltration of adjacent structures.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">They are usually solitary tumours, but multiple reports have been described that raise suspicions of Noonan syndrome or neurofibromatosis type 1.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> On T1-weighted sequences, GrCTs have been described as isointense or hyperintense to muscle,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8</span></a> although in our study, the intramuscular cases were hypointense to muscle (patients 2 and 3). The fat halo seen in the wrist lesion (patient 2) could reflect its benignity, although Elkousy et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> attributed it to the compression of adjacent tissues. In T2-weighted sequences, the central portion is usually isointense to the muscle, and may show a peripheral halo of high signal. Thus, our findings are consistent with the literature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Post gadolinium uptake may be observed, although in the article by Blacksin et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> uptake was not uniformly intense. The ‘stripe sign’ is a characteristic feature described due to lines caused by alternating muscle fibres (intermediate signal on T1-, T2- and proton density-weighted images) and tumour cells with fibrous stroma (low signal on T1-, T2- and proton density-weighted images).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This sign is observed in cases of intramuscular location (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 3</a>), and is more evident in the sequences parallel to the lesion's longest axis, coinciding with the longitudinal arrangement of the muscle fibres.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The literature does not describe how this type of tumour behaves with respect to diffusion restriction and ADC values. The low ADC values could be due to the fibrous stroma component potentially limiting the Brownian movement of water molecules. We also found that cases showing restricted diffusion exhibited homogeneous contrast uptake.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The treatment of choice is surgery with adequate resection margins to reduce the risk of recurrence, which is more frequent in GrCTs with poorly defined contours than nodular tumours with defined margins, even when negative surgical margins are achieved.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Granular cell tumours (GrCTs) are rare neoplasms that can occur in multiple anatomical locations. On MRI they are generally isointense to muscle, with a characteristic ‘stripe sign’, and may exhibit gadolinium uptake. Our cases also revealed the presence of diffusion restriction with low ADC values.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical considerations</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare they have observed the professional ethical framework that obliges them to ensure respect for the dignity and privacy of individuals and for the confidentiality of the medical act.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Informed consent has been obtained from the patients and the study has been approved by our hospital’s ethics committee.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Author contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0075" class="elsevierStylePara elsevierViewall">Research coordinator: GIH.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0080" class="elsevierStylePara elsevierViewall">Development of study concept: GIH.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0085" class="elsevierStylePara elsevierViewall">Study design: GIH.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0090" class="elsevierStylePara elsevierViewall">Data collection: GIH, BCP, LZD.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0095" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: GIH, BCP.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0100" class="elsevierStylePara elsevierViewall">Data processing: GIH.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0105" class="elsevierStylePara elsevierViewall">Literature search: GIH, ALM.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0110" class="elsevierStylePara elsevierViewall">Writing of article: GIH, ALM.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9</span><p id="par0115" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: GIH, ALM.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10</span><p id="par0120" class="elsevierStylePara elsevierViewall">Approval of the final version: GIH, BCP, ALM.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1993258" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1710330" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1993259" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1710329" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical cases" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical considerations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Author contributions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-11-27" "fechaAceptado" => "2022-12-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1710330" "palabras" => array:2 [ 0 => "Granular cell tumor" 1 => "Magnetic resonance imaging" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1710329" "palabras" => array:2 [ 0 => "Tumor de células granulares" 1 => "Resonancia magnética" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Granular cell tumors (GrCT) are histologically unique neoplasms that often manifest as painless solitary nodules located in the dermis or submucosal tissue. In this article we analyze the radiologic features of this type of tumor in five patients by magnetic resonance imaging (MRI), analyzing morphologic and signal characteristics. MR imaging findings were similar to other publications and we demonstrate low ADC values in our series.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los tumores de células granulares (TCGr) son neoplasias histológicamente únicas que a menudo se manifiestan como nódulos solitarios indoloros localizados en la dermis o en el tejido submucoso. En este artículo analizamos las características radiológicas de este tipo tumores en cinco pacientes mediante resonancia magnética (RM), analizando las características morfológicas y de señal. Los hallazgos radiológicos de la RM de nuestros pacientes fueron similares a otras publicaciones y en nuestra serie evidenciamos unos valores ADC bajos.</p></span>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2383 "Ancho" => 3175 "Tamanyo" => 524914 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 2. Axial T1-weighted sequence (a) showing the GrCT (arrow) in the muscle belly of the flexor carpi radialis, which is hypointense to the muscle with a thin hyperintense halo, also observed on the T2-weighted sequence (b). Fusion of T2-weighted and DWI imaging (c) and ADC values (d) we observed predominantly peripheral restriction with ADC of 0.525 × 10<span class="elsevierStyleSup">−3</span>. After gadolinium administration, we observed predominantly peripheral enhancement in axial (e) and coronal (f) T1-weighted fat saturated (T1FS) sequences; in the latter coronal plane, the characteristic ‘stripe sign’ (arrowheads) can be seen.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2383 "Ancho" => 3175 "Tamanyo" => 983319 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient 4. Coronal T1-weighted sequence (a) showing the GrCT (arrow) in the subcutaneous tissue of the right buttock, with spiculated contours, also isointense to the muscle in the axial T2-weighted sequence (b). In the T1FS sequence after gadolinium administration (c) we observe diffuse uptake. With the T2-weighted/DWI fusion image (d) and the ADC values (e) we observe a predominantly diffuse restriction with ADC of 0.624 × 10<span class="elsevierStyleSup">−3</span>. In the histological study (f) we observed connective tissue containing aggregates of polygonal cells with eosinophilic granular cytoplasm and small isomorphous ovoid nuclei between the collagen fibres. Positive for S100 protein (g).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2383 "Ancho" => 3175 "Tamanyo" => 532681 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patient 3. Axial T1-weighted sequence (a) shows the well-defined GrCT (arrow) in the muscle belly of the vastus lateralis, hypointense to the muscle, and also hypointense on the axial T2-weighted sequence (b). With the T2-weighted/DWI fusion image (c) and the ADC values (d) we observe a predominantly peripheral restriction with ADC of 0.947 × 10<span class="elsevierStyleSup">−3</span>. After gadolinium administration we observed a predominantly peripheral enhancement in the coronal (e) and axial (f) T1FS sequences; in this case the striped pattern (‘stripe sign’) was only seen in the coronal post-contrast sequence (arrowheads).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient no. \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Origin \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Size (mm) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Margins \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">T1-W signal \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">T2-W signal \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Restricted diffusion \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ADC value (×10<span class="elsevierStyleSup">−3</span> mm<span class="elsevierStyleSup">2</span>/s) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Uptake \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spiculated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.841 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intramuscular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Well defined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypo to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.525 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extremities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intramuscular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Well defined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypo to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.947 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spiculated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diffuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.624 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Homogeneous \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spiculated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iso to muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diffuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.857 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Homogeneous \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3312017.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical and radiological findings for our cases.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granular cell tumor: a clinicopathologic study of 110 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 3 | 2 | 5 |
| 2024 September | 5 | 0 | 5 |
| 2024 August | 4 | 2 | 6 |
| 2024 July | 1 | 0 | 1 |
| 2024 June | 2 | 0 | 2 |
| 2024 May | 8 | 2 | 10 |
| 2024 April | 2 | 0 | 2 |
| 2024 March | 1 | 1 | 2 |
| 2023 October | 2 | 1 | 3 |
