PMC3882933_01
A) Non-enhanced CT shows a huge presacral homogenous mass displacing the vagina anteriorly and the rectum on the right side. B) Sagittal multiplanar reformation of contrast-enhanced CT clearly depicts a fat plan between the heterogeneously enhancing mass and the sacrum.
rt-2013-4-e61-g001.jpg
PMC3882933_01_rt-2013-4-e61-g001.jpg
fig001
Computed tomography (CT) detected a presacral well demarcated lobulated mass, measuring 12.5x9x10 cm; the lesion was homogenously hypoattenuating relative to muscles on non-contrast enhanced scans and inhomogeneously hyperattenuating on contrastenhanced scans; neither intratumoral fat nor calcium deposits were evident (Figure 1A). The mass displaced the rectum on the right side, the vagina and the uterus anteriorly, without evidence of local spread or erosion of the sacrum and the coccyx (Figure 1B).
A) The mass present intermediate signal on T1-weighted MRI; tiny linear structures of voiding signal, due to hypertrophic vessels, are recognizable within the lesion. B) The lesion is heterogeneous on sagittal T2-weighted MRI. C) The mean apparent diffusion coefficient value measured on ADC map is 1210x10-3 mm/s. D) The mass strongly enhances after intravenous gadolinium injection. Spots of signal void and small non-enhancing areas, corresponding to high flow vessels and fibrotic changes respectively, are also appreciable.
rt-2013-4-e61-g002.jpg
PMC3882933_01_rt-2013-4-e61-g002.jpg
fig002
The mass was homogenously isointense to the muscles on T1-weighted MRI (Figure 2A). T2-weighted MRI the mass was well demarcated by a hypointense capsule and heterogeneous but hyperintense on T2-wheighted fat saturation images (Figure 2B); diffusion weighted images demonstrated a water diffusion restriction (Figure 2C). The mass strongly enhanced after intravenous gadolinium contrast medium administration; small non-enhanced foci and hypertrophic vessels were also appreciable (Figure 2D).
A) Left panel (H&E, 20x): typical vascular pattern of the SFT. Right panel (H&E, 40x): SFT with extramedullary hematopoiesis (black arrows: megakariocytes; white arrow: an erythroid island). B) Extramedullary hematopoiesis: immunohistochemical staining highlighting megakariocytes (CD61), nucleated erythroid cells (CD71) and granulocyte precursors (myeloperoxydase).
rt-2013-4-e61-g003.jpg
PMC3882933_01_rt-2013-4-e61-g003.jpg
fig003
Microscopically it was a mesenchymal neoplasm characterized by ovoid or spindle cells with focal nuclear pleomorphism and by a prominent branching, hemangiopericytomalike vascular pattern (Figure 3A).