PMC9619145_01
Transverse ultrasound image through the scrotum shows a partially imaged extratesticular mass (white arrows), area of central necrosis (red arrows), right testis (yellow arrow), and partially imaged right hydrocele (blue arrow).
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An ultrasound (US) image of the scrotum demonstrated a heterogeneous extratesticular mass on the right scrotum, the borders of which were distinct from the testicle and epididymis, and a reactive hydrocele (Fig. 1, Fig. 2 and 2).
H&E (10x) shows pleomorphic spindle cells with eosinophilic cytoplasm forming fascicles intersecting at right angles.
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Microscopically, the tumor is composed of pleomorphic spindle cells with eosinophilic cytoplasm forming fascicles intersecting at right angles (Fig. 3).
H&E (10x) showing large area of necrosis (pink geographic area).
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There are large areas of necrosis, marked cytologic atypia, and brisk mitotic activity (Fig. 4, Fig. 5 and 5).
Desmin immunostain (10x) shows the tumor is strongly and diffusely positive for desmin, and negative for myoD1 and myogenin (not shown) by immunohistochemistry, supporting their smooth muscle lineage.
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Immunohistochemical stains show the tumor cells are strongly and diffusely positive for desmin, and negative for myoD1 and myogenin, supporting their smooth muscle lineage (Fig. 6).
Long-axis superficial ultrasound image of the left upper arm shows a soft tissue mass (yellow arrow).
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US of the left upper extremity demonstrated a 2.2 x 2.1 x 1.5 cm heterogeneous solid vascular mass displacing the neighboring musculature (Fig. 7). US of the left lower extremity showed a 2.6 x 1.4 x 1.2 cm heterogeneous hypoechoic solid vascular mass displacing the neighboring musculature.
Axial IV contrast-enhanced CT image through the pelvis shows a soft tissue nodule in the right inguinal region compatible with lymph node metastasis (yellow arrow).
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CT CAP with contrast exhibited solid nodules in the right scrotum and right inguinal region, indicating local recurrence (Fig. 8).
Axial IV contrast-enhanced CT image through the chest shows subcentimeter pulmonary nodules in the right middle lobe and in the left lower lobe (blue arrows).
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Solid bilateral pulmonary nodules were present in the right middle and left lower lobes, suggestive of metastases (Fig. 9).