PMC4709879_01
The finding of pelvic MRI at surgery of the uterine rhabdomyosarcoma. The sagittal section of an MRI showed a heterogeneously enhanced huge mass, measuring approximately 15 x 10 cm in diameter, arising possibly from the uterine corpus and, completely filling the lumen of markedly enlarged uterus
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Fig1
The sagittal section of a pelvic MRI revealed a heterogeneously enhanced huge mass, measuring approximately 15 x 10 cm in diameter, arising possibly from the uterine corpus and, projecting into and completely filling the lumen of markedly enlarged uterus (Fig. 1).
Microscopic examination of the transvaginal brushing cytology specimen from the uterine mass (uterine embryonal rhabdomyosarcoma). a The cytologic specimen contained several individual cells or small clusters of atypical tumor cells having hyperchromatic round to oval nuclei, inconspicuous nucleoli, and pleomorphic and occasionally characteristic unipolar "tadpole"-shaped (inset) cytoplasm, in a background of severe necrosis and many degenerated squamous cells. Bar = 25 mum. b Retrospectively thorough examination could find out cytoplasmic cross-striations-like structures (arrowheads) in one of atypical spindle-shaped tumor cells. Bar = 25 mum
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Fig2
Moreover, the specimen from the transvaginal brushing cytology contained several individual cells or small clusters of atypical tumor cells having hyperchromatic round to oval nuclei, inconspicuous nucleoli, and pleomorphic and occasionally characteristic unipolar "tadpole"-shaped cytoplasm, in a background of severe necrosis and many degenerated squamous cells (Fig. 2a). Retrospectively thorough microscopic examination could find out cytoplasmic cross-striations-like structures in one of atypical spindle-shaped tumor cells (Fig. 2b).
Gross findings of the resected specimen of embryonal rhabdomyosarcoma arising from the uterine corpus. The cut surface showed exophytic polypoid mass lesions with a whitish to white-grayish, necrotic (left upper) appearance, measuring more than approximately 11 x 7 cm, protruding from the endometrial mucosa, but not involving the deep myometrium and uterine cervix (left)
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Fig3
A total abdominal hysterectomy and salpingo-oophorectomy were thus performed, and gross examination displayed an exophytic polypoid mass with a whitish to white-grayish, necrotic appearance, measuring more than approximately 11 x 7 cm, protruding from the endometrial mucosa, but not involving the deep myometrium and uterine cervix (Fig. 3).
Microscopic examination of the resected embryonal rhabdomyosarcoma arising from the uterine corpus. a The viable polypoid lesions were composed predominantly of a diffusely cellular and solid proliferation of highly atypical spindle-shaped cells arranged focally in bundles. Bar = 50 mum. b On high-power view, there were many admixed characteristic rhabdomyoblasts having abundant densely eosinophilic, and round (left) to tadpole- or strap-shaped (right) cytoplasm. Bar = 25 mum. c In addition, these atypical cells sometimes contained distinct cross-striations (left). Phosphotungstic acid-hematoxylin (PTAH) staining (right) was able to clearly reveal these cross-striations (arrowheads). Bar = 25 mum. d On the other hand, the neoplastic foci partly coexisted with cellular primitive small blue round to oval cells Bar = 50 mum
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Fig4
Microscopically, its viable polypoid lesions were composed predominantly of a diffusely cellular and solid proliferation of highly atypical spindle-shaped cells arranged focally in bundles with patchy and small acellular foci (Fig. 4a), oppressingly involving the only superficial layer of myometrium. On high-power view, there were many admixed characteristic rhabdomyoblasts having abundant densely eosinophilic, and round to tadpole- or strap-shaped cytoplasm (Fig. 4b) with sometimes distinct cross-striations (Fig. 4c). Phosphotungstic acid-hematoxylin (PTAH) staining was able to clearly reveal these cross-striations (Fig. 4c). In addition, these neoplastic foci partly coexisted with cellular primitive small blue round to oval cells (Fig. 4d).
Immunohistochemical examination of the resected embryonal rhabdomyosarcoma arising from the uterine corpus. (a, b) These highly atypical tumor cells were specifically positive for myogenic markers, such as desmin (a cytoplasmic pattern) and myogenin (b: nuclear pattern). Bars = 25 mum
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Fig5
Immunohistochemically, the atypical tumor cells were specifically positive for desmin (Dako, diluted 1:150) (Fig. 5a), pan-muscle actin (HHF-35; Enzo, New York, USA, diluted 1:20) and myogenin (Dako, diluted 1:30) (Fig. 5b), whereas completely negative for alpha-smooth muscle actin (alpha-SMA; Dako, diluted 1:150), caldesmon (Dako, diluted 1:50), CD10 (NOVOCASTRA laboratories Ltd., Newcastle, United Kingdom, diluted 1:20), cytokeratins (AE1/AE3; CHEMICON International, Inc., Temecula, California, USA, diluted 1:200, and Cam5.2; Becton Dickinson Immunocytometry Systems, San Jose, California, USA, diluted 1:1), S-100 protein (Dako, diluted 1:900) and HMB-45 (Enzo, diluted 1:100) (data not shown).