PMC7427024_01
Abdominal computed tomography with oral and intravenous contrast demonstrating a homogenous retroperitoneal neoplastic mass measuring 7.9 x 5.8 x 4.9 cm (green arrows on left image) with displacement of the gastroesophageal junction and lesser curvature of stomach. A soft tissue mass involving the terminal ileum measuring 4.6 x 3.0 x 4.1 cm and a 1.7-cm mid-mesentery mass are also noted (green arrows on right image).
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No evidence of obstruction was noted (see Figure 1).
Esophagogastroduodenoscopy revealed extrinsic compression of the fundus suggesting an underlying mass or lesion. No endoluminal gastric masses/lesions were appreciated. Computed tomography-guided biopsy later revealed this to be epithelioid mesothelioma originating from the retroperitoneal space.
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Esophagogastroduodenoscopy confirmed concerns for extrinsic compression of gastroesophageal junction and fundus of stomach suggesting an underlying mass; no endoluminal gastric mass/lesions were appreciated (see Figure 2).
Computed tomography chest with intravenous contrast identified moderate diffuse emphysema, a right upper lung lobe spiculated mass measuring 4.5 cm (green arrows) and indeterminate small left upper and lower lobe nodules. As this did not involve the pleura, as is traditionally seen, this was felt to be a metastasis of the primary retroperitoneal mass with metastasis to lungs and ileum.
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Computed tomography chest with IV contrast identified moderate diffuse emphysema, a right upper lung lobe spiculated mass measuring 4.5 cm, and indeterminate small left upper and lower lobe nodules (see Figure 3).
Hematoxylin and eosin stain of the retroperitoneal mass (20x). Malignant mesothelioma that is somewhat pleomorphic but mostly epithelioid. Polygonal cells with some spindling are seen. Cells have pleomorphic nuclei, occasionally multinucleated with moderate amount of eosinophilic cytoplasm. Nuclei have a vesicular chromatin pattern with distinct nucleoli. There is no obvious glandular or squamous differentiation.
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Hematoxylin and eosin staining revealed pleomorphic malignancy nuclei containing a vesicular chromatin pattern and prominent nucleoli (see Figure 4).