PMC6031592_01
Brain MRI. Arrows indicate Bilateral symmetrical occipital cortico-subcortical high T2/FLAIR signal intensity suggesting a vasogenic oedema within the occipital and parietal regions most likely relating to the posterior cerebral artery supply This confirm Posterior Reversible Encephalopathy Syndrome (PRES).
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MRI revealed bilateral symmetrical occipital cortical-subcortical high T2/FLAIR signal intensity highly suggestive of PRES (Fig. 1).
Computed tomography: Left panel, mesenteric mass with mixed hyper- and hypo- attenuating areas on arterial phase imaging; Right panel: similar appearing lesion in segment II liver.
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No invasion or mass effect for the adjacent structuresand a 4 cm solitary lesion of the left liver consistent with metastasis from the mesenteric lesion (Fig. 2).
Upper panel: Gross appearance of mesenteric sarcoma on left and liver metastasis on right.. Lower panel: Each lesion bi-valved.
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The operation was completed in 2 h, with less than 20 cc of blood loss (Fig. 3). Cut surface is grayish and fibrillary with negative resection margins (Fig. 3, Fig. 4, Fig. 5, Fig. 6).
Left: Smooth muscle actin (SMA) staining extensively positive.. Central: Caldesmon stain, extensively positive (brown areas).. Right: Desmin stain.. All consistent with leiomyosarcoma.
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Cut surface is grayish and fibrillary with negative resection margins (Fig. 3, Fig. 4, Fig. 5, Fig. 6).
Note various appearances of recurrent lesions; some are purely hypervascular (white arrow), others hypodense with some enhancement (black arrows) yet others with almost a mirror image enhancement pattern (dashed arrow).
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Repeat imaging revealed fairly extensive, multifocal intrahepatic recurrence, but no extra-hepatic disease (Fig. 7).