PMC9852908_01
(A) Timeline of the occurrence of major clinical events. (B) Computed Tomography image before neoadjuvant radiotherapy.
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Subsequent abdominal and pelvic CT imaging revealed a right retroperitoneal mass with a maximum diameter of 44.5cm, protruding into the right inguinal space ( Figures 1A, B ).
(A) It shows variably sized adipocytes with fibrous stroma, containing atypical cells with hyperchromatic nuclei and marked pleomorphism. (hematoxylin-eosin; original magnification x200). (B-D) The neoplastic cells are immunoreactive for CDK4 (original magnification x400), p16 (original magnification x400), and MDM2 (original magnification x200) respectively.
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Moreover, the neoplastic cells were immunoreactive for CDK4, p16 and MDM2 ( Figures 2B-D ). Figure 2 ). Following the excision of the right scrotal tumor, the patient developed abdominal fullness with vomiting and fever up to 38.5 degree Celsius.
The isodose curves that show (A) renal parenchymal sparing and the coverage of the target tumor mass in (B) the peritoneal and (C) the inguinal area.
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The radiation oncologist manually contoured on cross-sectional CT simulation images and measured target volume using segmentation tool programs, Eclipse and Pinnacle ( Figure 3 ). Later on, the residual tumor mass in the right scrotum also received a total dose of 70Gy in 35 fractions ( Figure 3 ).
Computed Tomography images showing evidence of tumor shrinkage (A) after neoadjuvant radiotherapy plus conversion surgery, (B) after adjuvant chemotherapy AIM (ifosfamide, Mesna, and doxorubicin) and MAID (Mesna, doxorubincin, ifosfamide, and dacarbazine) regimens, and (C) after ifosfamide chemotherapy.
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Abdominal CT survey also suspected residual tumor (ycT2bN1M0, stage III) in the right inguinal area and the right pelvic wall ( Figure 4A ). At the completion of adjuvant chemotherapy ( Figure 4B ), the maximum tumor diameter decreased from approximately 11 cm to 8 cm. Fortunately, after 18 cycles of ifosfamide monotherapy, no evidence of recurrence was found on abdominal CT ( Figure 4C ).