PMC8057779_01
(a, b): Pre-operative CECT abdomen axial + coronal images showing a large hypodense mesenteric lesion with mild heterogeneous post-contrast enhancement displacing small bowel loops to the left side and ascending colon posteriorly and abutting inferior surface of liver with no obvious infiltration. (c, d): CECT abdomen at recurrence axial + coronal images showing a heterogeneously enhancing lesion in the left subdiaphragmatic region abutting the superior surface of the spleen with indentation and loss of fat plane. (e, f): CECT abdomen axial + coronal images showing a heterogeneously enhancing lesion in the right paravesical region indenting the right lateral wall of urinary bladder with loss of fat plane. (g, h): Two months post-Ceritinib CECT abdomen axial images showing complete resolution of a right paravesical lesion and near-complete resolution of the left subdiaphragmatic lesion.
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figure1
Contrast-enhanced computed tomography (CECT) scan of chest, abdomen and pelvis showed a large ill-defined homogenous hypodense lesion of size 8.4 x 11.4 x 11.3 cm (APxTRAxSag), predominantly on the right side of the abdomen and in the midline showing mild heterogeneous post-contrast enhancement on delayed images (at 5 minutes) (Figure 1a and b). She developed abdominal pain 6 months after surgery and imaging (CECT) showed recurrent disease in right paravesical and left subdiaphragmatic regions (Figure 1e and f). Response assessment after 2 months showed a near-complete response with the disappearance of the paravesical lesion and 95% reduction of the subdiaphragmatic lesion (Figure 1g and h).
(a): Low-power photomicrograph of the tumour showing cells arranged in fascicles and a haphazard pattern with an oedematous background and admixed inflammatory cells. (b): High-power picture showing spindle cell population exhibiting myofibroblastic differentiation with mild-to-moderate nuclear pleomorphism, finely dispersed chromatin and moderate-to-abundant cytoplasm. The inflammatory cells are rich in plasma cells with lymphocytes and few oeosinophils (H&E 200x). (c): Immunostain for ALK-1 on D5F3 Ventana platform showing diffuse nuclear reactivity in 100% of the tumour cells with myofibroblastic differentiation. (d): Immunostain for SMA showing cytoplasmic reactivity in cells with myofibroblastic differentiation.
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Variable mitosis was seen (4-5/10 per high-power field) (Figure 2a and b). Tumour cells showed diffuse nuclear immunoreactivity for ALK-1 protein (100%) on D5F3 Ventana platform and cytoplasmic positivity for smooth muscle actin (SMA) and desmin (Figure 2c and d).