PMC8249757_01
Diagram of the disease progression.
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F1
No other symptoms were present (Figure 1).
Imaging examination. (A) Plain and enhanced MRI scanning of the knee joints and hip joints showed that the synovium of bilateral knee and hip joints were slightly thickened and enhanced, with a small amount of effusion in joints. (B) Plain CT scanning of lungs showed multiple nodules and stripe-shaped shadows in bilateral lungs, and the size of the largest shadow was 0.63 x 0.74 cm. (C) Plain and enhanced MRI scanning of the skull showed nodular lesions at the parasellar and meninges of the right parietal lobe. (D) Plain and enhanced MRI scanning of the spine showed bone mass destruction of the L2 vertebral body and left vertebral pedicle.
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F2
Plain and enhanced MRI scanning of the skull, pituitary, and spine showed nodular lesions at the parasellar and meninges of the right parietal lobe and bone mass destruction of the L2 vertebral body and left vertebral pedicle (Figure 2).
Pathological examination of the biopsy of lesion tissues of the L2 vertebral body. (A) The bone tissue were invaded by tumor cells (HE x 100). (B) The tumor cells was spindle-shaped, with abundant cytoplasm, red stain and mild atypia, while no evident nuclear fission was observed (HE x 200). (C) The actin were expressed in the cytoplasm of tumor cells (IHC x 400). (D) The highest ki-67 positive index was 6% (IHC x 400). (E) The h-Caldesmon were expressed diffusely in the cytoplasm of tumor cells (IHC x 400). (F) SMA were expressed diffusely in the cytoplasm of tumor cells (IHC x 400). (G) Epstein-Barr virus encoded RNA situ hybridization showed diffusely positive (EBER x 400).
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F3
The diagnosis was not made until after the second biopsy of a positive EBER in-situ hybridization was performed (Figure 3).