PMC8672373_01
(a) Hematoxylin and eosin (H&E) stain at 4x magnification showing soft tissue mass with pale eosinophilic amorphous deposits of material with associated multinucleated giant cells (arrow). (b) H&E stain at 10x magnification showing a vessel (arrowhead) with perivascular amyloid deposition (arrow).
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She underwent wide local excision and the histopathology showed abundant eosinophilic material with associated lymphoplasmacytic infiltration (Figure 1).
(a) Congo Red stain at 20x showing "apple green" birefringence characteristic of amyloid (arrow). (b) Immunohistochemistry showing staining positive for amyloid P (arrow). (c) Immunohistochemistry showing staining positive for amyloid A (arrow).
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The cells were positive for amyloid P, amyloid A, but inconclusive for kappa and lambda light chains (Figure 2).
Axial view of MRI of the left lower extremity showing subcutaneous nodular lesion (red arrow) with post-contrast enhancement (blue arrow).. Abbreviation: MRI, magnetic resonance imaging.
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Magnetic resonance imaging (MRI) confirmed the recurrence of the previous tumor (Figure 3).
Axial view of MRI of the left lower extremity showing multiple subcutaneous nodular lesions (red arrow) with post-contrast enhancement (blue arrow).. Abbreviation: MRI, magnetic resonance imaging.
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The MRI of the left leg showed at least 4 new enhancing lesions concerning for recurrence of recurrence (Figure 4).
(a) PET scan showing hypermetabolic uptake in bilateral lower extremities (blue arrows). (b) MIP image of PET scan identifying numerous hypermetabolic lesions in bilateral lower extremities (red arrow).. Abbreviations: MIP, maximum intensity projection; PET, positron emission tomography.
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The PET scan also showed a new hypermetabolic area medial to the left knee with no other hypermetabolic activity elsewhere (Figure 5).
MIP image of a whole body PET scan identifying numerous hypermetabolic lesions in bilateral lower extremities, left more than right side (red arrow). No evidence of any other hypermetabolic areas was noticed.. Abbreviations: MIP, maximum intensity projection; PET, positron emission tomography.
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The PET-CT showed multiple bilateral lower extremity hypermetabolic lesions with a dominant left side lesion (Figure 6).
MIP image of whole body PET scan showing improvement in the previously noticed hypermetabolic lesions in bilateral lower extremities (red arrows).. Abbreviations: MIP, maximum intensity projection; PET, positron emission tomography.
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Repeat PET scan after 2 cycles of bortezomib and dexamethasone showed improvement in the previous hypermetabolic lesions (Figure 7).