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X-ray Right hip AP view shows lytic area with surrounding sclerosis (arrow)in the femoral head. Soft tissue opacity in the thigh on the medial aspect (star).
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Radiograph of right femur and pelvis was done (Fig. 1).
Coronal STIR Sequence shows abnormal bright signal in the femoral head, neck, ilium, Right Gluteus & Right adductor muscles. Right extensive subcutaneous edema.
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Magnetic resonance imaging of the whole spine and pelvis, including thigh, was done (Figs. 2, 3, 4A and B), which showed asymmetrical muscular enlargement with abnormal signal intensity and heterogeneous enhancement involving bilateral pelvic musculature more on the right side and right proximal thigh musculature, confirming the characteristics of a malignant mass.
T2 sagittal and T1 sagittal post contrast images showing partial multilevel vertebral collapse more severe at T12 and L2 vertebrae with abnormal marrow signal.
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Magnetic resonance imaging of the whole spine and pelvis, including thigh, was done (Figs. 2, 3, 4A and B), which showed asymmetrical muscular enlargement with abnormal signal intensity and heterogeneous enhancement involving bilateral pelvic musculature more on the right side and right proximal thigh musculature, confirming the characteristics of a malignant mass.
(A) MRI Both Thigh Axial T1 with fat Sat without contrast. (B) MRI Both Thigh Axial T1 with fat Sat with contrast. Image reveal diffuse involvement of adductor and gluteus muscles of right side which shows post contrast enhancement and area of necrosis.
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Magnetic resonance imaging of the whole spine and pelvis, including thigh, was done (Figs. 2, 3, 4A and B), which showed asymmetrical muscular enlargement with abnormal signal intensity and heterogeneous enhancement involving bilateral pelvic musculature more on the right side and right proximal thigh musculature, confirming the characteristics of a malignant mass.
The H&E section reveals fibromuscular tissue infiltrated by diffuse, monotonous atypical cells with crushing (streaking) artifact. Tumor necrosis is abundant.
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Ultrasound-guided biopsy of the right gluteal lesion was done, and histopathology slides were reviewed (Figs. 8, 9A and B).
A and B The tumor cells are strongly and diffusely positive with CD20 with high proliferative index; Ki67 is almost 80%.
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Ultrasound-guided biopsy of the right gluteal lesion was done, and histopathology slides were reviewed (Figs. 8, 9A and B).
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CT axial image shows right retroperitoneal mass involving psoas muscle.
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Computed tomography (CT) angiogram of abdomen and pelvis was done for further clarification, which revealed a large right-sided retroperitoneal hematoma along the right psoas muscle (Fig. 5), extending for a length of approximately 16.5 cm, with a maximum transverse dimension of 8.5 cm.
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PET MIP show extensive bony metastasis.
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Sclerotic foci were also noted with decreased tracer accumulation (Fig. 7).
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Sagittal CT scan shows multiple collapse of the vertebral bodies, most severe is noted at T12 &L2.
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Almost a stationary course of the osseous involvement with collapse of the vertebral bodies DV4, DV9, DV12, LV1, and LV2 was noted (sagittal CT Spine, Fig. 6).
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