PMC9723381_01
(A) Contrast-enhanced CT found that the larger cross-section range is about 167*149*65 mm; moderate uneven enhancement occurred after the enhancement; obscure boundary, unresolved from the adjacent transverse colon and part of the small intestine. Multiple effusion dilations were seen in the ascending colon and part of the small intestine. (B) The position of the tumor in the abdominal cavity and its relationship with various organs were displayed by 3D reconstruction imaging of CT. (C) A huge external pressure mass under the mucosa at the middle section of the transverse colon (approximately 65 cm away from the anus) made the intestinal lumen compressed, twisted, and narrow. (D) The tumor involved the middle part of the transverse colon and part of the bladder wall. The size was about 18 * 12 * 6 cm. (E) The pictures of tumor pathology sections; order is: x40, x100, CKpan (+), desmin (+), NSE (+), vim (+). (F) Project name: EWSR1/WT1 fusion gene test (FISH-tissue). Detection probe: LBPEWSR1/WT1 fusion gene probe. Chromosome loci: WTl (llpl3)/EWSRl (22ql2). Probe tag: green signal is GSPEWSR1, red signal (R) is the GSPWT1 detection result. Cell number analyzed: 200; Diagnostic opinion: The EWSR1/WT1 fusion gene was detected, 200 interval phase cells were analyzed, and each signal pattern was as follows: 1G1R1F39.0%, 1G1R2F20.0%, 1G1F4.0%, lG2F 5.0%, lRlF 5.0%, lR2F 4.0%, lGlR 9.0%, 2GlR 5.0%, lG2R 4.0%, 2G2R 5.0%.
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Contrast-enhanced CT of the abdomen showed that a large, mass-confounding density was occupied in the omentum majus area of the middle and lower abdominal wall ( Figure 1A ). A 3D reconstruction of the images was performed ( Figure 1B ). To clarify the relationship between tumor and colon, colonoscopy was performed ( Figure 1C ). The complete tumor was removed and elevated colostomy was performed. ( Figure 1D ) The operation time of the patient was 282 minutes, the intraoperative bleeding was 100 ml, and there was no postoperative complication. The neoplasm involved the surrounding adipose tissue and was infiltrated into the intestinal and bladder wall. ( Figure 1E ) Immunohistochemistry showed that the tumor cells differentiated into epithelium, muscle, and nerve. Fluorescence in situ hybridization (FISH) revealed EWSR1-WT1 gene rearrangement at 22q12, confirming the diagnosis of a desmoplastic small round cell tumor ( Figure 1F ).