PMC10070302_01
Clinicopathological features of the thigh leiomyosarcoma. Gadolinium-enhanced T1-weighted magnetic resonance imaging demonstrating a heterogeneously enhanced tumor in the right thigh (a), hematoxylin and eosin staining indicate dense tumor cell proliferation with necrosis and hemorrhage (b), and tumors showing spindle cells with highly pleomorphic nuclei (c).
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F1
Magnetic resonance imaging (MRI) revealed a contrast-enhanced tumor with a hemorrhagic and unclear border [Figure 1a]. Necrosis and hemorrhage were also observed [Figures 1b and c].
Radiographic features of the metastatic brain tumor derived from leiomyosarcoma of the thigh. Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) demonstrating multiple brain tumors (a and b, arrows). Computed tomography and MRI showing the right frontal tumor with a surrounding hematoma (c-e). MRI indicating total resection of the tumor (f).
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F2
Two years after the initial surgery, MRI revealed multiple brain tumors in the frontal and temporal lobe, and brain stem [Figures 2a and b]. CT and MRI demonstrated a progressive tumor of the right frontal lesion, which was 50 mm in maximum diameter, including peritumoral hemorrhage [Figures 2c-e]. To avoid further neurological deterioration, we performed an en bloc tumor and hematoma resection [Figure 2f].
Pathological characteristics of the metastatic brain tumor derived from leiomyosarcoma of the thigh. Macroscopic view showing the tumor (arrowhead) and the surrounding hematoma (arrows) (a). Hematoxylin and eosin staining indicates diffuse growth of atypical cells with necrosis (arrowhead) and hemorrhage (arrows) (b). Hemorrhage comprising tumor cells (c). Tumor cells showing spindle and epithelioid features with highly pleomorphic nuclei (d). Immunostaining for desmin (e), caldesmon (f), Ki-67 (g), vascular endothelial growth factor (h), and CD31 (i). Thin-walled vessels are prominent within the tumor (i, arrows).
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F3
Macroscopic findings indicated that the tumor had extended to the subpial surface and was surrounded by hemorrhage [Figure 3a]. Microscopic examination revealed spindle and epithelioid cells with marked nuclear pleomorphism and necrosis and hemorrhage [Figures 3b-d]. Tumor cells were present in the hematoma [Figure 3c]. Immunohistochemical analysis demonstrated that the tumor cells were positive for smooth muscle markers (desmin and caldesmon), and the Ki-67 index was approximately 15% [Figures 3e-g]. In addition, vascular endothelial growth factor (VEGF) was diffusely expressed in the tumor cells [Figure 3h], and abnormal blood vessels with thin walls were prominent within the tumor [Figure 3i].