Multimodal ultrasound for preoperative evaluation of dermatofibrosarcoma protuberans: a series of 40 cases

Figures

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  Fig. 1. A DFSP with three nodules in the chest wall of a 22-year-old woman. B Transverse ultrasonogram (No. 1) revealing a well-defined, hypoechoic, homogeneous, and subcutaneous lesion. C 3-D color Doppler ultrasonogram revealing wrapped blood flow signal. D Transverse ultrasonogram (No. 2) revealing an ill-defined, hypoechoic with finger-like projections and posterior hyperechoic area, heterogeneous, and subcutaneous lesion. E 3-D color Doppler ultrasonogram revealing branch-shaped blood flow signal. F Transverse ultrasonogram (No. 3) revealing an ill-defined, mixed, heterogeneous, and subcutaneous lesion. G 3-D color Doppler ultrasonogram revealing branch-shaped blood flow signal

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  Fig. 2. A DFSP with three nodules in the right face of a 48-year-old man. B Transverse ultrasonogram revealing an ill-defined, hypoechoic with finger-like projections and posterior hyperechoic area, heterogeneous, and subcutaneous lesion extending from the skin to bone. C Color Doppler ultrasonogram revealing intralesional and peripheral vascularity and rich vascularization with vascular densities reaching 4.5/cm2. D Power Doppler ultrasound revealed artery with peak systolic blood flow velocity of 47.0 cm/s and resistance index of 0.57. E Elastography showing an elasticity score of 3. F Contrast-enhanced ultrasound revealed the trend that contrast agent enters (the 26th second after the injection of contrast agent) the lesion from the bottom to the center. G Contrast-enhanced ultrasound revealed heterogeneous hyper-enhancement at peak (the 50th second after the injection of contrast agent), with the maximum diameter and depth of 4.3 cm and 2.1 cm respectively

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  Fig. 3. A, DFSP with reddish plague in the right waist of a 36-year-old woman. B Transverse ultrasonogram revealing a well-defined, mixed with a hyperechoic ring, heterogeneous, and subcutaneous lesion. C Color Doppler ultrasonogram revealing intralesional and peripheral vascularity and rich vascularization with vascular densities reaching 3.5/cm2. D Contrast-enhanced ultrasound revealed the trend that contrast agent enters the lesion from the bottom to the center. E Contrast-enhanced ultrasound revealed heterogeneous hyper-enhancement at peak (the 20th second), with the maximum diameter and depth of 2.4 cm and 1.6 cm respectively. F Time intensity curve revealed peak of 23.4. G The hypoechoic area correlated with a storiform growth pattern on histology (hematoxylin-eosin × 40)

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  Fig. 4. A DFSP with atrophic plague in the left thigh of a 40-year-old woman. B Transverse ultrasonogram revealing an ill-defined, inverted triangle hyperechoic subcutaneous with hypoechoic area in the sunken dermis, heterogeneous, and subcutaneous lesion. C Color Doppler ultrasonogram revealing intralesional vascularity and poor vascularization with vascular densities reaching 1.0/cm2. D Elastography showing an elasticity score of 4. E Contrast-enhanced ultrasound revealed the trend that contrast agent enters (the 5th second after the injection of contrast agent) the lesion from the bottom to the center. F Contrast-enhanced ultrasound revealed heterogeneous hyper-enhancement at peak (the 45th second after the injection of contrast agent), with the maximum diameter and depth of 2.15 cm and 1.1 cm respectively. G The hyperechoic area correlated with a honeycomb invasive pattern in the subcutaneous tissue on histology (hematoxylin-eosin × 40)