PMC9458873_01
Timeline. A graphic depiction of the timeline of events in this case.
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F1
Her abdomen was noted to be distended and taut with prominent abdominal veins (Figure 1).
Radiographs. Supine (A) and left lateral decubitus (B) radiographs demonstrated pneumoperitoneum on day of life 3.
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F2
The patient's pediatrician sent the patient to the emergency department where an abdominal X-ray revealed a large volume of pneumoperitoneum concerning for bowel perforation (Figure 2).
Histological examination of neoplasm. (A) Prominent vasculature is identified within some areas of the spindle cell neoplasm, with several vessels demonstrating a staghorn-like appearance (H&E, scale bar is 200 microns). (B) At higher power, the neoplastic cells are monomorphic, ovoid to spindled, with a moderate amount of cytoplasm and coarse chromatin, and scattered apoptotic bodies are noted (H&E, scale bar is 50 microns). (C) At the site of perforation, the neoplastic cells are seen infiltrating through the muscularis propria and into the serosa and surrounding fibroadipose tissue (H&E, scale bar is 500 microns). (D) These nests of neoplastic cells are away from the main site of perforation and are identified as percolating through the submucosa (H&E, scale bar is 500 microns).
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F3
A microscopic tumor was identified at the site of the perforation (Figure 3).