PMC9942219_01
MRI pelvis showing an enhancing soft-tissue mass infiltrating into the pubic bone and adjacent muscles. MRI: Magnetic resonance imaging. Red arrows show locally infiltrating nature of the tumor
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F1
A pelvic magnetic resonance imaging was obtained, which revealed an enhancing soft-tissue mass infiltrating the left pubic bone, adductor brevis, and the inferior rectus abdominis muscles, with the right spermatic cord structures appearing inseparable from the mass as shown in [Figure 1].
(a) Intraoperative picture showing a locally infiltrating soft-tissue mass (b) Resected specimen with negative surgical margins (c) Tumor bed after complete resection. *Tumor
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F2
An open wide local excision of the mass, including an anterior pubectomy was performed [Figure 2] and the histopathology showed spindle cells arranged in short intersecting fascicles and in focal storiform pattern, admixed with dense lymphoplasmacytic infiltrate, along with multiple neutrophilic abscesses and areas of necrosis, compatible with the diagnosis of inflammatory atypical lipomatous tumor/well-differentiated liposarcoma, FNCLCC Grade 1.
Histopathological evaluation (a) H and E staining: Well-circumscribed tumor compressing the surrounding tissue (a: H and E, x20); large atypical spindle cells (black arrowhead) in vague fascicles, infiltrated by dense mixed inflammatory cells (white arrowhead) (b: H and E, x100); large multinucleated tumor cells (black arrowheads) and atypical mitosis (white arrowhead) (c: H and E, x 200) (b) IHC markers: Atypical spindle cells (arrowhead) showing nuclear positivity for MDM2 on immunohistochemistry (a;IHC,x200); tumor cells showing negativity for ALK (b;IHC,x200) and CD34 (c;IHC,x200) on immunohistochemistry
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F3
Nuclear positivity for MDM2 on immunohistochemistry confirmed the diagnosis [Figure 3].