PMC8085435_01
CE-CT exam: Axial (a) coronal (b) and sagittal (c) CE-CT images shows a 6 cm x 4 cm multilobed mass (white arrow) characterized by both solid (Hyperdense) and cystic (hypodense) component (white arrowhead) with homogeneous enhancement and close proximity (black arrowhead) to sigmoid wall (black arrow).
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F1
A contrast-enhanced computed tomography (CE-CT) scan of abdomen and pelvis showed, in the pre-sacral space, the presence of a multi-lobed mass (6 cm x 4.5 cm in diameters) characterized by both solid and cystic components with homogeneous enhancement in close proximity to rectal wall (Figure 1).
MRI exam: Axial (a) coronal (b) and sagittal (c) T2-weighted images shows a 6 cm x 4 cm multilobed mass (white arrow) characterized by both solid and cystic component (white arrowhead) with fluid-fluid level (hemorragic); axial T1-weighted fat-suppressed pre-contrast (d), and arterial (e) and delayed (f) post-contrast phase shows omogeneous enhancement of the mass with no clivage plane toward the sigmoid wall (black arrow).
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F2
A contrast-enhanced magnetic resonance imaging (CE-MRI) of the pelvis confirmed the well-defined, multi-lobed mass characterized by solid and cystic component with hemorrhagic content (fluid-fluid level); homogeneous enhancement of the mass and adherence to the rectal wall were detected (Figure 2).
Pathological findings: (A) H&E staining of the mass, showing a thick smooth muscle layer lined by endometrial epithelium and stroma (10x); (B) immunohistochemical analysis of CD10 showing a diffuse expression in the endometrial stroma without staining of the endometrial mucosa (20x); (C) PAX8 nuclear expression limited to the endometrial mucosa (40x); (D) smooth muscle actin (SMA) expression in the smooth muscle layer (10x).
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F3
The muscular component was diffusely positive for smooth muscle actin (Figure 3).