PMC6744786_01
Coronal T1-weighted (a) and T2-weighted contrast- enhanced (b) magnetic resonance imaging of the left arm and axillary region, showing a heterogeneous mass involving part of the left infraclavicular plexus and left brachial plexus.
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F1
Contrast enhancement revealed uptake in several lymph nodes, presumed secondary to metastatic spread [Figure 1].
Photograph taken during subtotal surgical resection of the lesion, showing the musculocutaneous nerve (black arrow), median nerve (white arrow), and antebrachial medial cutaneous nerve (white arrowhead), all liberated from the tumor, while the brachial artery (under the median nerve, circled by the red loop) still enveloped by tumor.
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F2
We observed that it originated from the lateral division of the upper trunk of the left BP, invading surrounding structures and adhering to other BP elements, including the axillary/brachial artery and veins [Figure 2].
Fragments of the tumor after resection, all of very firm consistency that collectively weighed roughly 250 g.
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F3
At a macroscopic level, the resected tumor fragments together weighted 300 g and all had a firm consistency [Figure 3].
Microscopic view of the tumor. (a) Intense and diffuse cytoplasmic dot-like desmin stain of tumor cells. Desmin, original x200. (b) Nests of round and rhabdoid tumor cells. Hematoxylin and eosin stain, original x400.
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F4
Immunohistochemistry profile showed positive staining for desmin (dot-like pattern), AE1/3, WT1 (nuclear pattern), as well as CD56 and CD99 [Figure 4].