PMC5996408_01
T1 MRI images of malignant PEComa metastasis exerting mass effect in both (a) sagittal and (b) axial views.
CRIPA2018-5749421.001.jpg
PMC5996408_01_CRIPA2018-5749421.001.jpg
fig1
The tumor was noted in the temporal lobe of the brain, orbital bones, and lumbar spine (Figures 1 and 2).
Initial CT imaging of the abdomen and pelvis with and without contrast for evaluation of the inguinal mass in (a) coronal, (b) sagittal, and (c) axial views demonstrating superficial extension and involvement of anterior abdominal wall by mass and (d) axial view demonstrating a proximal cross-sectional view of the mass that is not extending to the superficial skin.
CRIPA2018-5749421.002.jpg
PMC5996408_01_CRIPA2018-5749421.002.jpg
fig2
The tumor was noted in the temporal lobe of the brain, orbital bones, and lumbar spine (Figures 1 and 2).
Histology and immunochemistry of malignant PEComa. (a) Malignant cells in a concentric arrangement around blood vessels (H&E, 100x). (b) Epithelioid cells with granular light eosinophilic cytoplasm and oval nuclei with small nucleoli (H&E, 400x). (c) Melan-A demonstrates salient cytoplasmic immunoreactivity, supporting melanocytic phenotype (Melan-A (MART-1), 400x). (d) HMB-45 demonstrates salient cytoplasmic immunoreactivity, supporting melanocytic phenotype (HMB-45, 400x).
CRIPA2018-5749421.003.jpg
PMC5996408_01_CRIPA2018-5749421.003.jpg
fig3
The predominant pattern was that of the malignant cells concentrically located around hyalinized medium-sized blood vessels (Figure 3).
Histology and cytology of malignant PEComa. (a) Sheets of polygonal epithelial cells with hyperchromatic nuclei with prominent nucleoli and brisk mitotic activity (H&E, 400x). (b) Epithelioid cell clusters in a hemorrhagic background (Papanicolaou stain, 400x). (c) Medium cellular aspirate in hemorrhagic background (Papanicolaou stain, 400x). (d) Pleomorphic cells with enlarged nuclei with conspicuous nucleoli and light eosinophilic cytoplasm (Papanicolaou stain with oil, 1000x).
CRIPA2018-5749421.004.jpg
PMC5996408_01_CRIPA2018-5749421.004.jpg
fig4
The less prominent pattern was that of the malignant cells arranged in sheets forming cords or nodules (Figure 4). Occasionally, intranuclear inclusions were noted (Figure 4).