PMC9666284_01
Whole body FDG PET scan. (a): Pretherapy PET/CT shows increased tracer uptake in the thoracic, liver and multiple skeletal regions in maximum intensity projection image (A).Trans-axial fused PET/CT and CT sections shows multiple random distribution parenchymal nodules in the lungs (white arrows) and large necrotic peripheral FDG avid lesion in segment VII/VIII of the liver measuring 5.3 x 5.5 cm .Also noted FDG avid lytic lesions noted in D10 vertebra (blue arrows). (b): Post-therapy PET/CT shows increased tracer uptake in the thoracic, liver and multiple skeletal regions in maximum intensity projection image (A).Trans-axial fused PET/CT and CT sections shows multiple random distribution parenchymal nodules in the lungs(white arrows) and large necrotic peripheral FDG avid lesion in segment VII/VIII of the liver measuring 7.3 x 6.1 cm. Compared to pretherapy PET/CT scan there is increase in size of liver lesions along with increase in number of lung and skeletal lesions suggestive of progressive disease.
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A baseline positron emission tomography (PET) scan (Figure 1a) revealed lytic and sclerotic lesions with increased fluoro-deoxy glucose (FDG) uptake in the entire axial and appendicular skeleton, multiple subpleural and parenchymal lung nodules and discrete hypodense lesions in segment 7/8 of liver. He had disease progression following two lines of therapy, namely cyclophosphamide-doxorubicin (Figure 1b) and gemcitabine-docetaxel.
Histopathology images. (a and b): Histological examination of the tumour showing cells arranged predominantly in cords surrounded by dense collagenous stroma. The individual tumour cells exhibit mild to moderate nuclear pleomorphism with finely dispersed chromatin and abundant eosinophilic cytoplasm with characteristic epithelioid morphology. (c): Immunohistochemistry for MUC 4 showing diffuse immunoreactivity in the tumour cells.
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Subsequently liver biopsy was repeated and sent again for expert review, which revealed a collagenising spindle cell proliferation comprised of epithelioid and short spindled cells with ovoid nuclei, fine chromatin, inconspicuous nucleoli and scanty eosinophilic cytoplasm (Figure 2a and b). The tumour cells expressed MUC 4 (Figure 2c), while S-100, SOX10, desmin, smooth muscle antigen, CD34 and ETS-related gene were negative, suggestive of SEF.