PMC3977166_01
Histomorphology of thigh mass showing sheets of epithelioid cells with pleomorphic eccentric nuclei (A, B and C) that showed immunoreactivity for desmin (D). Skeletal muscle bundles served as internal positive control for desmin (Haematoxylin and Eosin staining x200 for A and C and x400 for B, Immunohistochemical staining x200 for D).
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Most of these malignant cells showed abundant eosinophilic cytoplasm with occasional eccentric nuclei (Figure 1A, B). Some areas showed clear cell changes (Figure 1C). The neoplastic cells showed positivity for desmin (Figure 1D) and vimentin and the mass was designated at that time as pleomorphic rhabdomyosarcoma.
Gross picture of abdominal mass showed grayish white discoulration with friability and necrosis.
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The mass measured 30x24x10 cm with whitish lobulated cut section (Figure 2A, B).
Histopthological picture of abdominal mass showing malignant neoplasm with conventional clear areas (A), granular esinophilic cytoplasm (B and C), anaplastic areas with monster cells (D and E) and abnormal mitosis (F) (Haematoxylin and Eosin staining x400 for B, D and E, x200 for C and F).
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Microscopic evaluation of the abdominal mass revealed malignant epithelial cells characterized by clear cytoplasm with variable degrees of pleomorphism, where there were areas of moderate pleomorphiam to anaplastic areas (Figure 3).
One of metastatic lymph node (A) (Haematoxylin and Eosin staining x200). The malignant cells of thigh mass showed diffuse positivity for CD10 (B) and focal positivity for CK (C) and EMA (D) (Immunohistochemical staining x200).
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Three iliac lymph nodes were dissected and revealed infiltration by the same neoplasm (Figure 4A). The tumor cells were diffusely positive for CD10 (Figure 4B) and vimentin and focally positive for pan cytokeratin (Figure 4C) and EMA (Figure 4D).
CD10, CK, EMA and carbonic anhydrase IX expression in malignant cells of thigh mass, respectively (Immunohistochemical staining x400).
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For our surprise, the tumor cells of thigh mass were diffusely positive for CD10 (Figure 5A), and vimentin and focally positive for pan cytokeratin (Figure 5B), EMA (Figure 5C) and carbonic anhydrase (Figure 5D) and still showed immunoreactivity for desmin.