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Lymphangiolipoma of the lower extremity: 5-year radiological follow-up after radiotherapy treatment

F Bruns, MD W Steitz, MD P Schueller, MD U Schaefer, MD N Willich, PhD and O Micke, MD

Department of Radiation Oncology, University of Muenster, Albert-Schweitzer-Straße 33, D-48129 Muenster, Germany.



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  		Figure 1. Lymphangiolipoma of the left thigh in a 15-month-old girl. The anteroposterior and lateral radiographs of the lower extremities show a large non-specific soft-tissue mass of the lower two-thirds of the left thigh without cortical destruction. The almost homogeneous mass is limited to the compartment of the quadriceps femoris muscle and contains three rounded areas of calcification.

 


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  		Figure 2. Recurrent lymphangiolipoma of the left thigh in the same patient aged 21 years. (a) Axial and (b) sagittal T1 weighted (TR/TE, 800/20) spin-echo MR images with gadolinium-DTPA reveal a large, smoothly marginated mass along the group of vastus muscles. The lesion shows mixed signal characteristics containing areas with signal isointense with fat, corresponding to the lipomatous component, and areas slightly hyperintense relative to muscle after application of gadolinium-DTPA, corresponding to the lymphangiomatous component. (c) CT scan (8 mm slice thickness) obtained at 15 cm above the knee joint revealed a heterogeneous, mixed attenuation circumferential lobulated extraosseous mass, a mixture of soft-tissue and fat replacing the normal muscles in the compartment. No periostal reaction was seen. In comparison with the right thigh, there is a loss of volume of thegroup of vastus muscles following repeated resections.

 


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  		Figure 3. Follow-up imaging after radiotherapy. (a) After 2 years, the axial T1 weighted (TR/TE, 800/20) spin-echo MR image with gadolinium-DTPA shows a distinct regression of the lymphangiomatous component in all involved muscles. Subcutaneous fibrosis-like structural changes are due to surgical scars. (b) After 5 years, the axial T1 weighted (TR/TE, 800/20) spin-echo MR image with gadolinium-DTPA shows nearly complete regression of the lymphangiomatous component, whereas the lipomatous component persists.

 




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