 Hello everyone, my name is Dr. Velichad Sandeep. I am a radiologist from India, Andhra Pradesh. I am going to present case-based review sessions which are mainly in the field of neuro radiology including pediatric neuro radiology, some interesting cases of musculoskeletal radiology and some body MRI cases. Today I have got a musculoskeletal soft tissue tumor case to show you. So, this is one of my co-authors Dr. Revikiran who is a orthopedician. This is a 15 month old child presented with painless swelling, multiple soft tissue swelling, palpable subcutaneously. They are slowly growing since over the period of one year. They are progressive in nature, in growth. Rest of the body does not show any significant similar abnormality. So, this radiograph initially came to us. We can appreciate the extensive soft tissue surrounding the ankle joint which is extending to the foot. Initially, my initial impression was there is some bony destruction with fragmentation of this bone by the tumor. But in musculoskeletal radiology and limb x-rays always you need to take a comparative radiograph on the opposite side. So, once you take the opposite side, you can easily understand that there is no bony destruction. All the tarsal bones remain same pattern compared to the opposite side. So, this is extensive soft tissue mass lesion associated with extensive calcification. These are like a chunky calcification does not fit into any particular amorphous calcification does not fit into any classical description otherwise. So, this we need to further investigate to characterize the soft tissue mass to find out any particular etiology. So, we have investigated further with MRI. This is MRI T2 weighted image which shows multiple nodules which are T2 hypointens. You will find capsule there is no clear cut capsule they are projecting subcutaneous planes they are extending into slightly deeper planes anterior lateral and extending posteriorly as well. And there are some cystic areas or hyper intense areas they are not frankly cystic areas but most of predominantly it is shows T2 hypointense areas and T1 is also it is showing hypointensity homogenous. So, what are the possibilities for this hypointensity the T2 hypointensity the least is like uric acid or it can be fibrous tissue. It can be amylite tissue it can be haemorrhages melanin all these are T2 hypointense things in musculoskeletal radiology or overall anywhere in the body. So, among all these things the best possibility here is a fibrous tissue. So, we consider that is a most likely a fibrous tissue we have given contrast but central part most of the central part is not showing significant nodular enhancement. There is some peripheral enhancement at some of the nodules there is in there is no intense homogenous enhancement in the center of the nodules. So, we thought we are dealing with a fibrous tumor in a pediatric age group which is showing some enhancement but not impressive enhancement. Most of the tumor has been excised and it assured this particular histopathology of spindle cells associated with mixoid background and areas of calcification. So, before we see the final histopathology report let us analyze and discuss the possible differential diagnosis for this type of tumor. So, common tumor what are the common tumors of the pediatric foot. So, I do believe that large referral population age and location charts done at two decades before a larger studies. So, I do follow them and according to that the common tumor in this locations in benign category are congenital hemangioma. It can be like slow flow vascular modification congenital hemangioma niche rich whatever criteria. Usually these are T2 hyperintense predominantly associated with multiple flow voids and calcifications. That calcifications are usually well defined tribolids and that picture is not there in our case. Fibromatosis very much in consideration that differentials. Granular manual is more of inflammatory lesion subcutaneous plane. So, this may not exactly fit into the deeper fibrous signals. Infantile digital fibromatosis is more of distal comes in the toes and fingers it's more distal. So, what are the malignant tumors of the pediatric foot are Dermatofibrosarcoma. These differentials holds the tumors which are less than 5 years or mostly less than 2 years. Dermatofibrosarcoma protuberance can come at this age group also but it is mostly subcutaneous malignancy. Fibrosarcoma is very much in the differential diagnosis. The pattern of calcification can be here and there and there is no impressive enhancement and the period of growth is over a period of a year. So, that is a doubtful diagnosis compared to the benign fibromatosis. Dermatofibrosarcoma is one of the things which is like a heterogeneous presentations. But usually there are more T2 hyperintense than this and shows impressive enhancement and faint peripheral enhancement like this. So, we have considered fibromatosis as a leading diagnosis and given genital hyaline fibromatosis a highly possible diagnosis in our report. That's how it turned out to be also in histopathology wise as well. So, the case final diagnosis, genital hyaline fibromatosis. This is basically a soft tissue lesion with the preparation of fibroblasts in abundant collagen matrix. These fibrous tumors have various signal intensities based on the collagen nature, fibrous nature and cellular T in between the fibrous tissue. It can be T2 isointense to the adjacent muscle. It can be commonly hypointense and rarely it can be hyperintense and sometimes when you have an acrosis or other things that might change the signal to hyperintense. This can be superficial and deep. They are classified like that. These are related conditions. It may not be exactly the same conditions in the pathophysiology and progression. These are other related conditions are pommar fibromatosis. Signals wise, this all looks more or less same. Plantar fibromatosis, they have specific names as well. Phenyl fibromatosis also can be nicely depicted now with MRI. So, we used to think these conditions may not have genetic basis but this is clearly consaginous Marais and autosomal resistive disease which has come out now. So, we have to warn the parents that there is chance of 25% in the next pregnancy. The surgical problem with this is they are prone to recurrence. Some of the varieties are very much prone for recurrence. So, these are the common locations most in the years. Some of them are very progressive. Some of them are static. Here scalp back and knees are most commonly affected sites for this fibromatosis group of disorders. Even abdominal desmoid tumors also comes and related to these fibromatosis lesions. So, this has been published by Dr. Ravi in this journal. Acknowledgements to them too and our sincere acknowledgements to our Medical College. All the three departments who have participated in this case.