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Case Reports in Radiology
Volume 2013 (2013), Article ID 493752, 4 pages
http://dx.doi.org/10.1155/2013/493752
Case Report

Plexiform Neurofibroma of the Wrist: Imaging Features and When to Suspect Malignancy

San Fernando General Hospital, Independence Avenue, Paradise Pasture, San Fernando, Trinidad and Tobago

Received 21 February 2013; Accepted 20 March 2013

Academic Editors: M. Hashimoto, A. Matsuno, O. Strohm, and Y. Tsushima

Copyright © 2013 Maria Gosein et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Plexiform neurofibromas are essentially pathognomonic for neurofibromatosis type 1 (NF1), occurring when there is diffuse involvement along a nerve segment and its branches. Transformation into a malignant peripheral nerve sheath tumour (MPNST) is a major cause of mortality in NF1 patients. These tumours are highly aggressive and particularly difficult to diagnose in NF1 patients due to the clinical overlap between benign and malignant lesions. We present a case of a plexiform neurofibroma and discuss the typical imaging characteristics on ultrasound, CT, and MRI, including the target sign and continuity with the parent nerve. Certain imaging features should raise suspicion for malignancy however, these modalities may not always reliably differentiate between benign and malignant lesions. Recent studies show a very high negative predictive value for FDG-PET making it quite useful in excluding malignancy. In positive scans, PET/CT aids in guiding biopsy to the most metabolically active area of the tumour.