PMC6332634_01
Timeline of treatment
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PMC6332634_01_13569_2018_111_Fig1_HTML.jpg
Fig1
The patient underwent a resection of the intraabdominal mass with partial small bowel resection, resection of distal transverse and descending colon with enteroenterostomy, as well as colocolostomy, appendectomy and gastrostomy (Fig. 1). Two months after resection of the intra-abdominal mass, the tumor recurred (Fig. 1).
A, C, and E (bladder wall tumor): A highly cellular epithelioid (top right) and spindle cell (bottom left) malignancy involving the outer wall of the urinary bladder (A) (H&E x100). The cells demonstrate round to oval nuclei with variably prominent nucleoli, moderate eosinophilic cytoplasm and indistinct borders (C) (H&E x400). Immunohistochemistry shows diffuse reactivity for cytokeratin AE1/AE3 and calretinin (inset) (E) (IHC x100). B, D, and F (remote abdominal tumor): A moderately cellular malignancy with intermixed spindled and epithelioid cells involving the outer gastric wall (B) (H&E x200). The cells demonstrate irregular nuclei with prominent multiple eosinophilic nucleoli, abundant eosinophilic cytoplasm and indistinct borders (D) (H&E x400). Immunohistochemistry shows reactivity for cytokeratin AE1/AE3 and negative calretinin (inset) (F) (IHC x100)
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PMC6332634_01_13569_2018_111_Fig2_HTML.jpg
Fig2
The gastric wall tumor showed a high-grade spindle cell neoplasm with focal epithelioid features (Fig. 2B). Subsequent studies performed 20 years later (Fig. 2) included immunohistochemical stains showing patchy reactivity for vimentin, cytokeratin AE1/AE3 and cytokeratin 7, while other markers tested, including gastrointestinal stromal tumor and smooth muscle markers were negative. Pathologic examination of the bladder wall tumor showed a 5.5 cm high-grade malignancy with epithelioid and sarcomatoid features (Fig. 2A).