PMC4583115_01
Echocardiography and CTPA images of the patient.. Notes: (A, B) Echocardiography demonstrated severe tricuspid valve regurgitation with an estimated right ventricular systolic pressure of 103 mmHg; (C-E) computed tomography pulmonary angiogram showed filling defect of the pulmonary artery, and there was no tumor in the lung field.. Abbreviation: CTPA, computed tomography pulmonary angiogram.
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Emergency abdominal ultrasonography indicated hepatic congestion, subsequent transthoracic echocardiography demonstrated right ventricular dilation and severe tricuspid valve regurgitation with an estimated right ventricular systolic pressure of 103 mmHg (Figure 1A, B). Computed tomography pulmonary angiogram (CTPA) showed a large filling defect within the main pulmonary trunk and extending into the right and left pulmonary arteries (Figure 1C-E), bilateral lower-extremity venous duplex scan was negative for deep venous thrombosis.
Histopathologic examination and immunohistochemistry staining of tumor cells.. Notes: Histopathologic examination of the tumor showed spindle cells with nuclear pleomorphism, arranged in fascicles and with massive necrosis (A) (hematoxylin and eosin staining; magnification: 200x). Immunohistochemistry staining showed that the tumor cells were positive for VIM (B), SMA (C), Ki-67 (D), and CD99 (E), but negative for DES (F) (magnification: 200x).
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Histopathologic examination of the mass showed spindle cells with nuclear pleomorphism, arranged in fascicles and with massive necrosis (Figure 2A). Immunohistochemical staining of the tumor cells was positive for VIM, SMA, Ki-67, and CD99 (Figure 2B-E), but negative for DES (Figure 2F), S100, CK (pan), CD31, CD34, Actin, CD117, and CD68.
Images of the tumors.. Notes: (A, B) 18F-fluorodeoxyglucose uptake on positron emission CT showed accumulated radioactivity in middle and lower chest and no other hypermetabolic lesions were observed elsewhere; (C) CT pulmonary angiogram showed filling defect of the right pulmonary artery; (D) contrast-enhanced CT detected a right adrenal gland tumor after radioactive seed implantation; (E) contrast-enhanced CT detected a mass in the right hilum and pleural effusion.. Abbreviation: CT, computed tomography.
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18F-fluorodeoxyglucose uptake on positron emission computed tomography was performed to confirm the distant metastatic extent of the sarcoma, accumulated radioactivity in middle and lower chest was consistent with changes after surgery, and no other hypermetabolic lesions were observed elsewhere (Figure 3A, B). Six months after surgery, the sarcoma relapsed as an obstructive mass in the right pulmonary artery and the peripheral branches (Figure 3C). Another 5 months later, a right adrenal gland mass was detected by contrast-enhanced computed tomography (CT) (Figure 3D) which was pathologically proven to be a metastatic lesion from her sarcoma by puncture biopsy. Fifteen months after PEA, she was diagnosed with superior vena cava obstruction syndrome, contrast-enhanced CT showed a mass in the right hilum (Figure 3E).