PMC5902122_01
Contrast-enhanced CT of lower extremities. CT shows hypodense lesions and fluid collection in the medial aspect of the posterior compartment of the left lower leg.
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Contrast-enhanced CT showed hypodense lesions and fluid collection in the medial posterior compartment of the left lower leg (Figure 1).
Myonecrosis of the left lower leg. Intraoperative finding demonstrated myonecrosis of the deep posterior compartment and the posterior tibal nerve surrounded by necrotizing tissue (status after posterior tibial nerve neurolysis).
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Upon dissection into the deep compartment of posterior leg, myonecrosis of nearly the entire compartment was discovered, and the tibial nerve was surrounded by the necrotic soft tissue (Figure 2).
Microscopic view of intraoperative soft tissue specimen. (a) Infiltration of neoplastic cells in the soft tissue, characterized by high nuclear-to-cytoplasmic ratio in hematoxylin and eosin (H&E) stain. Positive in immunochemical stain: CD20 (b), bcl-2 (c), and c-myc (d) in immunochemical stain.
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Pathologic examination of the deep posterior compartment of the lower leg confirmed the diagnosis of B-cell lymphoma with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (Figure 3).
Chest radiograph revealed ARDS lung. (a) preoperative; (b) postoperative.
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On hospital day 22, the patient died because of intractable gastrointestinal bleeding and multiple organ failure in the intensive care unit (Figure 4).