PMC3681292_01
CT abdomen at presentation showed huge mass.
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fig1
CT scans of chest, abdomen, and pelvis with contrast showed huge pelvic-abdominal mass measuring 19 x 14.7 x 22 cm with extensive retroperitoneal lymphadenopathy, and liver and lung metastases (Figure 1).
(a) Foci of neoplastic cells consistent with germ cell tumor (H&E). (b) Foci of neoplastic cells consistent with germ cell tumor (Medium Power, H&E).
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fig2
CT-guided Tru-Cut biopsy of the mass showed a mixed germ cell tumor (Figures 2(a) and 2(b)) with predominantly seminomatous component (CD117 positive, Figure 3) and foci consistent with choriocarcinoma (beta-HCG positive, Figure 4).
CD117 positivity in the seminomatous component.
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fig3
CT-guided Tru-Cut biopsy of the mass showed a mixed germ cell tumor (Figures 2(a) and 2(b)) with predominantly seminomatous component (CD117 positive, Figure 3) and foci consistent with choriocarcinoma (beta-HCG positive, Figure 4).
beta-HCG positivity in foci suggestive of choriocarcinomatous component.
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fig4
CT-guided Tru-Cut biopsy of the mass showed a mixed germ cell tumor (Figures 2(a) and 2(b)) with predominantly seminomatous component (CD117 positive, Figure 3) and foci consistent with choriocarcinoma (beta-HCG positive, Figure 4).
CT abdomen after development of hemorrhagic shock showed multiple heterogeneously enhancing masses in the liver with peripheral enhancement. Also, there is intraperitoneal fluid.
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fig5
CT angiogram showed multiple enhancing hepatic metastasis with extensive blood leaking and pooling in the liver and to a lesser extent in the pelvic mass with large amount of intraperitoneal fluid (most likely hemoperitoneum) (Figure 5).