PMC7078455_01
MRI image of the tumor. Horizontal section (A). Sagittal section (B) of T1-contrast WIs. Horizontal section of T2 WIs (C). Sagittal section of fat suppression T2 WIs (D).
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MRI revealed high density in the T1-contrast weighted images (WIs) (Fig. 1A, B) and iso and multifocal high density in the T2-WIs (Fig. 1C). In the fat suppression T2-WIs, high-density area was recognized inside the tumor (Fig. 1D).
Histological image of FNA specimen.Different density areas of neoplastic cells are shown (A). High-density area of the tumor (B). Neoplastic cells have eccentric and eosinophilic cytoplasm (C). Mitosis is hardly observed (C). Neoplastic cells are embedded in the sclerotic stroma in the low-density area (D). Neoplastic cells are diffusely positive for vimentin (E) and MUC4 (F).
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There are regions of different density of tumor cells (Fig. 3A). The tumor cells have an eccentric and eosinophilic cytoplasm (Fig. 3B), with no increase in mitosis (Fig. 3C). In low-density area, abundant and weakly eosinophilic stroma can be seen (Fig. 3D). Immunohistochemistry revealed tumor cells that were diffusely positive for vimentin (Fig. 3E) and MUC4 (Fig. 3F), focally and weekly positive for CD99, and negative for AE1/AE3, CAM5.2, Myeloperoxidase, CD138, LCA, Myogenin, Desmin, alphaSMA, MyoD1, CD31, CD34, WT-1, ERG, D2-40, MDM2, c-kit, S100, HMB45, Melan A, and Mib-1 index is 3%.
Macroscopic, microscopic and FISH analyses of surgical specimens.. Tumor surface is white and boundary is well-defined (A). High- (B) and low- (C) density area of neoplastic cells. The latter area is sclerotic. Epithelioid feature of neoplastic cells (D). Break-apart signal of EWSR1 (E). The red labeled probes were situated proximal to EWSR1 and, the green labeled probes were situated distal to EWSR1. Arrows indicate fusion genes.
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The surface color of the tumor was white and the boundary between the surrounding muscle and the tumor surface was relatively well-defined despite absence of a tumor capsule (Fig. 4A). Even in the surgical specimen, regions with non-sclerotic high density of tumor cells (Fig. 4B) and sclerotic low density of tumor cells (Fig. 4C) were observed. In the Sclerosing area, corded growth of epithelioid cells within a densely sclerotic stroma, which is a typical feature of SEF, was also observed (Fig. 4D). We detected break-apart signals of EWSR1 (Fig. 4E) but, could not detect fusion signals of EWSR1-CREB3L1 or EWSR1-CREB3L2 (data not shown).