Pediatric Radiology

, Volume 47, Issue 12, pp 1555–1571 | Cite as

Imaging appearances of soft-tissue tumors of the pediatric foot: review of a 15-year experience at a tertiary pediatric hospital

  • Pablo Caro-Domínguez
  • Oscar M. Navarro


Tumors of the foot are rare in children. In this review the authors illustrate radiographic, sonographic and MR imaging findings of foot soft-tissue tumors in children based on all cases presenting at a tertiary pediatric hospital during the 15-year period of 1999–2014. Among these cases there were 155 tumors of the foot — 72 of the bones and 83 of the soft tissues. Vascular malformations, fibromatosis and sarcomas were respectively the most frequent benign, intermediate and malignant soft-tissue tumors. Some tumors showed specific imaging findings. In imaging investigations, ultrasound can be used as the first imaging modality for diagnostic workup of most lesions because it is noninvasive, low-cost and readily available, and can confirm the presence of the mass and evaluate cystic components, especially in young children who would otherwise require sedation for MR imaging. MR imaging is the reference standard technique because of its high tissue contrast, which allows for detection and characterization of soft-tissue and bone abnormalities. MR imaging is useful as the first imaging modality in select cases, including those with high suspicion of malignancy, very large lesions or pre-treatment lesions. Recognition of some typical imaging findings in pediatric soft-tissue foot tumors is helpful to establish diagnosis and facilitate patient management.


Children Foot Magnetic resonance imaging Neoplasm Soft-tissue tumor Ultrasound 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Kransdorf MJ, Murphey MD, Bralow L (1997) Imaging of soft tissue tumors, 1st edn. WB Saunders, PhiladelphiaGoogle Scholar
  2. 2.
    Navarro OM, Laffan EE, Ngan BY (2009) Pediatric soft-tissue tumors and pseudotumors: MR imaging with pathologic correlation. Part 1. Imaging approach, pseudotumors, vascular lesions, and adipocytic tumors. Radiographics 29:887–906CrossRefPubMedGoogle Scholar
  3. 3.
    Singer AD, Datir A, Tresley J et al (2016) Benign and malignant tumors of the foot and ankle. Skelet Radiol 45:287–305CrossRefGoogle Scholar
  4. 4.
    Gartner L, Pearce CJ, Saifuddin A (2009) The role of the plain radiograph in the characterisation of soft tissue tumours. Skelet Radiol 38:549–558CrossRefGoogle Scholar
  5. 5.
    Fornage BD, Rifkin MD (1988) Ultrasound examination of the hand and foot. Radiol Clin N Am 26:109–129PubMedGoogle Scholar
  6. 6.
    Paltiel HJ, Burrows PE, Kozakewich HP et al (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754CrossRefPubMedGoogle Scholar
  7. 7.
    Totty WG, Murphy WA, Lee JK (1986) Soft-tissue tumors: MR imaging. Radiology 160:135–141CrossRefPubMedGoogle Scholar
  8. 8.
    Gielen JL, De Schepper AM, Vanhoenacker F et al (2004) Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients. Eur Radiol 14:2320–2330CrossRefPubMedGoogle Scholar
  9. 9.
    Iyer RS, Thapa MM (2013) MR imaging of the paediatric foot and ankle. Pediatr Radiol 43:S107–S119CrossRefPubMedGoogle Scholar
  10. 10.
    Kim JS, Chandler A, Borzykowski R et al (2012) Maximizing time-resolved MRA for differentiation of hemangiomas, vascular malformations and vascularized tumors. Pediatr Radiol 42:775–784CrossRefPubMedGoogle Scholar
  11. 11.
    Guerini H, Omoumi P, Guichoux F et al (2015) Fat suppression with Dixon techniques in musculoskeletal magnetic resonance imaging: a pictorial review. Semin Musculoskelet Radiol 19:335–347CrossRefPubMedGoogle Scholar
  12. 12.
    Zou Y, Wang QD, Zong M et al (2016) Apparent diffusion coefficient measurements with diffusion-weighted imaging for differential diagnosis of soft-tissue tumor. J Cancer Res Ther 12:864–870CrossRefPubMedGoogle Scholar
  13. 13.
    Brisse H, Orbach D, Klijanienko J et al (2006) Imaging and diagnostic strategy of soft tissue tumors in children. Eur Radiol 16:1147–1164CrossRefPubMedGoogle Scholar
  14. 14.
    Fisher C (1996) Soft tissue sarcomas: diagnosis, classification and prognostic factors. Br J Plast Surg 49:27–33CrossRefPubMedGoogle Scholar
  15. 15.
    Fletcher CD, Hogendoorn P, Mertens F et al (2013) WHO classification of tumours of soft tissue and bone, 4th edn. IARC Press, LyonGoogle Scholar
  16. 16.
    Wassef M, Blei F, Adams D et al (2015) Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics 136:e203–e214CrossRefPubMedGoogle Scholar
  17. 17.
    Sheybani EF, Eutsler EP, Navarro OM (2016) Fat-containing soft-tissue masses in children. Pediatr Radiol 46:1760–1773CrossRefPubMedGoogle Scholar
  18. 18.
    Boybeyi O, Alanay Y, Kayikçioğlu A et al (2010) Hemihyperplasia-multiple lipomatosis syndrome: an underdiagnosed entity in children with asymmetric overgrowth. J Pediatr Surg 45:E19–E23CrossRefPubMedGoogle Scholar
  19. 19.
    Lee JC, Thomas JM, Phillips S et al (2006) Aggressive fibromatosis: MRI features with pathologic correlation. AJR Am J Roentgenol 186:247–254CrossRefPubMedGoogle Scholar
  20. 20.
    Sargar KM, Sheybani EF, Shenoy A et al (2016) Pediatric fibroblastic and myofibroblastic tumors: a pictorial review. Radiographics 36:1195–1214CrossRefPubMedGoogle Scholar
  21. 21.
    Murphey MD, Ruble CM, Tyszko SM et al (2009) Musculoskeletal fibromatoses: radiologic-pathologic correlation. Radiographics 29:2143–2173CrossRefPubMedGoogle Scholar
  22. 22.
    Vogel D, Righi A, Kreshak J et al (2014) Lipofibromatosis: magnetic resonance imaging features and pathological correlation in three cases. Skelet Radiol 43:633–639CrossRefGoogle Scholar
  23. 23.
    Kransdorf MJ, Meis JM, Jelinek JS (1991) Myositis ossificans: MR appearance with radiologic pathologic correlation. AJR Am J Roentgenol 157:1243–1248CrossRefPubMedGoogle Scholar
  24. 24.
    Lacout A, Jarraya M, Marcy PY et al (2012) Myositis ossificans imaging: keys to successful diagnosis. Indian J Radiol Imaging 22:35–39CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Gindele A, Schwamborn D, Tsironis K et al (2000) Myositis ossificans traumatica in young children: report of three cases and review of the literature. Pediatr Radiol 30:451–459CrossRefPubMedGoogle Scholar
  26. 26.
    Laffan EE, Ngan BY, Navarro OM (2009) Pediatric soft-tissue tumors and pseudotumors: MR imaging features with pathologic correlation: part 2. Tumors of fibroblastic/myofibroblastic, so-called fibrohistiocytic, muscular, lymphomatous, neurogenic, hair matrix, and uncertain origin. Radiographics 29:e36CrossRefPubMedGoogle Scholar
  27. 27.
    Gibbons CL, Khwaja HA, Cole AS et al (2002) Giant-cell tumour of the tendon sheath in the foot and ankle. J Bone Joint Surg Br 84:1000–1003CrossRefPubMedGoogle Scholar
  28. 28.
    Gonzalez S, Duarte I (1982) Benign fibrous histiocytoma of the skin. A morphologic study of 290 cases. Pathol Res Pract 174:379–391CrossRefPubMedGoogle Scholar
  29. 29.
    Mankin HJ, Casas-Ganem J, Kim JI et al (2004) Leiomyosarcoma of somatic soft tissues. Clin Orthop Relat Res 421:225–231CrossRefGoogle Scholar
  30. 30.
    Gordon RW, Tirumani SH, Kurra V et al (2014) MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: experience in 47 patients. Skelet Radiol 43:615–622CrossRefGoogle Scholar
  31. 31.
    Navarro OM (2016) Magnetic resonance imaging of pediatric soft-tissue vascular anomalies. Pediatr Radiol 46:891–901CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen MM Jr (2000) Klippel-Trenaunay syndrome. Am J Med Genet 93:171–175CrossRefPubMedGoogle Scholar
  33. 33.
    White CL, Olivieri B, Restrepo R et al (2016) Low-flow vascular malformation pitfalls: from clinical examination to practical imaging evaluation – part 1, lymphatic malformation mimickers. AJR Am J Roentgenol 206:940–951CrossRefPubMedGoogle Scholar
  34. 34.
    Rogers M, Lam A, Fischer G (2002) Sonographic findings in a series of rapidly involuting congenital hemangiomas (RICH). Pediatr Dermatol 19:5–11CrossRefPubMedGoogle Scholar
  35. 35.
    Subash A, Senthil GK, Ramamoorthy R et al (2015) Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon in a neonate of life- and limb-threatening nature: a case report. J Indian Assoc Pediatr Surg 20:194–196CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Bahnassy M, Abdul-Khalik H (2009) Soft tissue chondroma: a case report and literature review. Oman Med J 24:296–299PubMedPubMedCentralGoogle Scholar
  37. 37.
    Shapeero LG, Vanel D, Couanet D et al (1993) Extraskeletal mesenchymal chondrosarcoma. Radiology 186:819–826CrossRefPubMedGoogle Scholar
  38. 38.
    Lim R, Jaramillo D, Poussaint TY et al (2005) Superficial neurofibroma: a lesion with unique MRI characteristics in patients with neurofibromatosis type 1. AJR Am J Roentgenol 184:962–968CrossRefPubMedGoogle Scholar
  39. 39.
    Yikilmaz A, Ngan BY, Navarro OM (2015) Imaging of childhood angiomatoid fibrous histiocytoma with pathological correlation. Pediatr Radiol 45:1796–1802CrossRefPubMedGoogle Scholar
  40. 40.
    Jo VY, Antonescu CR, Zhang L et al (2013) Cutaneous syncytial myoepithelioma: clinicopathologic characterization in a series of 38 cases. Am J Surg Pathol 37:710–718CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    McCarville MB, Spunt SL, Skapek SX et al (2002) Synovial sarcoma in pediatric patients. AJR Am J Roentgenol 179:797–801CrossRefPubMedGoogle Scholar
  42. 42.
    Cypel TK, Meilik B, Zuker RM (2007) Extraskeletal Ewing’s sarcoma in a great toe of a young boy. Can J Plast Surg 15:165–168CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Bakst RL, Tallman MS, Douer D et al (2011) How I treat extramedullary acute myeloid leukemia. Blood 118:3785–3793CrossRefPubMedGoogle Scholar
  44. 44.
    Pui MH, Fletcher BD, Langston JW (1994) Granulocytic sarcoma in childhood leukemia: imaging features. Radiology 190:698–702CrossRefPubMedGoogle Scholar
  45. 45.
    Fritz J, Vogel W, Bares R et al (2007) Radiologic spectrum of extramedullary relapse of acute myelogenous leukemia in adults. AJR Am J Roentgenol 189:209–218CrossRefPubMedGoogle Scholar
  46. 46.
    Alyas F, Lee J, Ahmed M et al (2007) Prevalence and diagnostic significance of fluid–fluid levels in soft-tissue neoplasms. Clin Radiol 62:769–774CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Medical ImagingUniversity of TorontoTorontoCanada
  2. 2.Department of Diagnostic ImagingThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Department of Diagnostic ImagingHospital San Juan de Dios, Health Time GroupCórdobaSpain

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