PMC4158327_01
((a) and (b)) Permeative pattern in distal femur; (c) malignant looking lesion is corroborated with a MRI. MRI: magnetic resonance imaging.
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fig1
The physical examination revealed increased volume of the knee, tenderness, and edema, the X-ray showed a permeative pattern in distal femur (Figures 1(a) and 1(b)) without evidence of fracture; the malignant-looking lesion was corroborated with a MRI (Figure 1(c)).
Pulmonary nodules (arrows) in both hemithoraces on a CT scan.
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The evidence of pulmonary nodules (smaller than 1 cm) in CT scan suggested metastatic disease in both hemithoraces (Figure 2).
CT scan 3 months later reported multiple pulmonary nodules (arrows) that remain in number and dimension in relation to the previous CT.
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Months later a CT scan demonstrated that pulmonary nodules remained in number and dimensions in relation to the previous CT scan (Figure 3).
Nonanatomic pulmonary resection of superior and inferior left lobe was performed by posterolateral thoracotomy.
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fig4
Through posterolateral thoracotomy a nonanatomic pulmonary segment resection of right superior and inferior lobes with 60 mm blue cartridge GIA stapler (Covidien Surgical, Norwalk, CT, USA) was performed (Figure 4); the transoperatory biopsy described a white nodular lesion of approximately 1 cm extension with benign pattern.
Fibromuscular tissue growth with nonneoplastic ossification; immunohistochemistry nodules composed of cells, vimentin, AML, calponin, ALK1, a240, D, and Ki67 20%. AML: actina de musculo liso (smooth muscle actin).
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The final pathology report described benign fibromuscular proliferative lesions, cells forming nodes, by immunohistochemistry, vimentin, AML, calponin, ALK1, d240, re, and 20% of Ki67, (Figure 5) consistent with benign metastasizing leiomyoma, which was corroborated by three uterine myomas in a pelvic US (Figure 6).
Pelvic US shows uterine myoma in posterior wall of 30 x 25 x 20 mm. Two myomas in the interior wall.
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fig6
The final pathology report described benign fibromuscular proliferative lesions, cells forming nodes, by immunohistochemistry, vimentin, AML, calponin, ALK1, d240, re, and 20% of Ki67, (Figure 5) consistent with benign metastasizing leiomyoma, which was corroborated by three uterine myomas in a pelvic US (Figure 6).