PMC7724085_01
Chest CT. A: axial view, neoproliferative lesion in the anterior mediastinum (red arrow). B: coronal view, 14 x 10 x 7 cm prevascular lesion (red arrow). C: sagittal view, tumor in contact with the esophagus and trachea (red arrow).
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It also compromised SVC and it was in contact with the trachea and esophagus (Fig. 1).
A and B: PET-CT coronal view, with multiple hypermetabolic foci in the small bowel wall, in both adrenal glands, in the left kidney and a tumor with an infiltrative aspect in the tail of the pancreas. C and D: axial views of a voluminous hypermetabolic mass in the anterior mediastinum that encompasses the great vessels.
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In the abdominal cavity, hypermetabolic nodules were found in both adrenal glands, a left renal nodule, a lesion in the tail of the pancreas, and multiple hypermetabolic areas in the small bowel loops (Fig. 2).
Abdominal and pelvis CT. A, B, and C: presence of free intraperitoneal air (red circles) and free fluid in the decline regions of the abdomen.
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An abdominal CT scan showed the presence of extraluminal gas, free fluid, and paralytic ileus with parietal thickening with defect areas, compatible with multiple intestinal perforations (Fig. 3).
A: three isolated tumoral lesions are observed that were repaired with simple raffia. B, C and D: presence of consecutive lesions in the small bowel segment with transmural involvement and devitalized margins.
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An exploratory laparotomy was performed and revealed moderate enteric fluid in the abdominal cavity and six perforation sites on the wall of the small intestine, described from the angle of treitz to the ileocecal valve at 35, 40, 60, 130, 150, and 200 cm (Fig. 4).
A: mediastinum (HE 100x), central necrotic area (red rectangle), which indicates that the neoplasm is aggressive and proliferation of cells with scarce cytoplasm and hyperchromatic nuclei around it. B: small bowel (HE 100x), the intestinal mucosa is seen without neoplastic infiltration, while from the submucosa to the serosa it is infiltrated by the neoplasm. C: HE 400x, cells that infiltrate the intestine with the same characteristics as the mediastinal ones. D: IHC positive for CD20, identifying B lymphocytes. E: IHC positive for CD30. F: Ki67 +, with more than 50% of the cells in on mitosis indicating a high-grade lymphoma.
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