PMC6572897_01
Transverse sonogram (Phillips EPIQ5; Phillips Medical Systems) of the right
medial liver lobe. There was a large, heterogeneous mass (outlined by
callipers) containing a central fluid-filled component
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Abnormalities identified on abdominal ultrasound included a 5.0 cm diameter, large, heterogeneous and poorly vascularised mass within the right medial lobe of the liver, which was fluid-filled centrally (Figure 1), and an eccentrically located, intramural (2.0 cm x 1.4 cm) hypoechoic mass within the distal portion of the transverse colon with loss of normal wall layering (Figure 2).
Longitudinal sonogram of the transverse colon. There was an eccentric,
intramural hypoechoic mass within the distal portion of the transverse
colon. Note the displacement of the intraluminal gas interface by this
lesion (arrows)
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Abnormalities identified on abdominal ultrasound included a 5.0 cm diameter, large, heterogeneous and poorly vascularised mass within the right medial lobe of the liver, which was fluid-filled centrally (Figure 1), and an eccentrically located, intramural (2.0 cm x 1.4 cm) hypoechoic mass within the distal portion of the transverse colon with loss of normal wall layering (Figure 2).
Colonoscopy revealed a smooth, raised mass in the transverse colon
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Colonoscopy revealed a smooth, raised mass in the transverse colon and biopsies were collected (Figure 3).
CT images of the (a) transverse and (b) dorsal planes of the abdomen
displayed in a soft tissue window. The patient's right is to the left. There
was a large heterogeneous hepatic mass within the right medial lobe
(arrows). Note the heterogeneous post-contrast enhancement of the mass with
multiple coalescing non-enhancing regions suggestive of necrosis. Images
obtained with a 16-detector row CT scanner (Phillips 16-slice Brilliance CT
V2.3; Phillips Medical Systems [120 kVp, 100 mAs, 1.5 mm slice
thickness])
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A heterogeneous soft tissue-attenuating 4.3 cm mass was noted within the right medial lobe of the liver (Figure 4).
CT images of the (a) transverse and (b) dorsal planes of the abdomen
displayed in a soft tissue window. The patient's right is to the left. There
is an intramural hypoechoic mass within the transverse colon (arrows). Note
the heterogeneous, predominantly peripheral contrast enhancement of the
mass.
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Within the transverse colon, there was a hypoattenuating mass (2.4 cm x 1.4 cm x 0.6 cm) with heterogeneous, predominantly peripheral enhancement post-contrast administration (Figure 5).
Intraoperative image of the right medial liver lobe mass (arrow) adjacent to
the gall bladder
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The hepatic mass was separated from the gall bladder by blunt dissection and right medial and quadrate liver lobe resection performed because of shared vasculature (Figure 6).
Colonic mass. Neoplastic cells are arranged in interlacing streams and
bundles. Haematoxylin and eosin (x 400)
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Histopathology of the colonic mass (Figure 7) revealed a poorly circumscribed, unencapsulated, well-demarcated, densely cellular, infiltrative neoplasm composed of spindle cells arranged in interlacing streams and bundles separated by a scant eosinophilic fibrillary matrix that was transmurally infiltrating and effacing the mucosa, lamina propria, submucosa, tunica muscularis and serosa, and extending into the colonic lumen.
Hepatic mass. Neoplastic cells demonstrate similar behaviour to the colonic
mass (Figure 7).
Note the marked anisocytosis and anisokaryosis. Haematoxylin and eosin (x
400)
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Similar neoplastic infiltrates admixed with scattered single-cell necrosis infiltrated and replaced the architecture of the right medial liver lobe (Figure 8).
Colonic mass. Neoplastic cells demonstrate diffuse marked nuclear and
cytoplasmic labelling for S-100. Peroxidase immunohistochemistry and
haematoxylin and eosin (x 400)
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Immuno-histochemistry revealed that both masses stained positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a diagnosis of a MPNST (Figures 9-12).
Colonic mass. Neoplastic cells demonstrate diffuse marked cytoplasmic
labelling for vimentin. Peroxidase immunohistochemistry and haematoxylin and
eosin (x 400)
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Immuno-histochemistry revealed that both masses stained positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a diagnosis of a MPNST (Figures 9-12).
Hepatic mass. Neoplastic cells demonstrate diffuse marked cytoplasmic
labelling for glial fibrillary acidic protein. Peroxidase
immunohistochemistry and haematoxylin and eosin (x 400)
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Immuno-histochemistry revealed that both masses stained positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a diagnosis of a MPNST (Figures 9-12).
Colonic mass. Neoplastic cells demonstrate scattered faintly positive
cytoplasmic labelling for c-kit. Peroxidase immunohistochemistry and
haematoxylin and eosin (x 400)
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Immuno-histochemistry revealed that both masses stained positive for S-100 protein, vimentin and glial fibrillary acidic protein, very weakly positive for c-kit and negative for muscle-specific actin and CD18, consistent with a diagnosis of a MPNST (Figures 9-12).