PMC4080675_01
(a) Magnetic resonance imaging pelvis showing intermediate signal SOL with cystic areas and necrosis (block arrows). (b and c) Contrast enhanced computed tomography (CECT) thorax shows bilateral pleural nodules (arrows). (d-f) CECT 8 weeks after therapy shows 10% reduction of the dimensions of the pelvic mass and disappearance of right sided pleural nodule while left pleural nodule persists. (g and h) CECT after another 8 weeks shows further reduction in the size of the pelvic mass while left lower lobe of lung and perihilar regions show interstitial pneumonitis
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F1
Magnetic resonance imaging of pelvis showed complex SOL of size 8.6 cm x 8.1 cm x 6.8 cm with solid and cystic components, occupying the pelvis [Figure 1a]. CT scan of thorax and upper abdomen showed bilateral pleural nodules [Figure 1b and c]. Post week 8 CT thorax and abdomen revealed 10% reduction in size of pelvic mass and significant reduction in number and size of lung nodules [Figure 1d-f]. After another 8 weeks of temsirolimus, another CT scan showed further 25% reduction in the pelvic mass with small left pleural nodules but showed new development of diffuse ground glass opacities along with interlobular septal thickening in both lungs, predominantly in the perihilar regions, likely to be interstitial pneumonitis [Figure 1g and h].
Pelvic mass. (a) Section shows infiltrating neoplasm arranged in lobules separated by thick and thin fibrovascular septae with lymphoplasmacytic infiltrate (H and E, x40). (b) Tumor cells with abundant pale vacuolated cytoplasm, with moderate nuclear atypia and variably prominent nucleoli (H and E, x400). (c) Patchy positivity for HMB-45 (x400). (d) Patchy positivity for melan-A (x400)
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F2
Histopathology review revealed an infiltrating neoplasm arranged in lobules separated by thick and thin fibrovascular septae with lymphoplasmacytic infiltrate [Figure 2a]. Tumor cells showed abundant pale vacuolated or eosinophilic cytoplasm, round or oval nuclei with moderate nuclear atypia and variably prominent nucleoli [Figure 2b]. Melan-A, HMB-45, smooth muscle actin (SMA) and epithelial membrane antigen showed patchy positivity [Figure 2c and d].