PMC4891403_01
Initial CT examination, demonstrating a mass (M) posterior to the right abdominal wall. [PowerPoint Slide]
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This mass extended anteriorly to the posterior margin of the right abdominal musculature (Figure 1).
Repeat CT scan, showing a dumbbell-shaped right lower quadrant mass (M) in contact with the psoas muscle, extending through the abdominal wall into the overlying subcutaneous tissue. [PowerPoint Slide]
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Repeat CT scan of the pelvis (Figure 2, Figure 3) now demonstrated a 9.4 x 2.3 cm dumbbell-shaped right lower quadrant mass in contact with the psoas muscle, and extending through the abdominal wall into the overlying subcutaneous tissue.
3D reconstruction of lower abdomen from repeat CT scan data, showing mass (M) protruding through abdominal wall.. A. Left anterior oblique view from a horizontally rotating 3D movie (QuickTime, 9.4 MB) shows the mass, as well as the subcutaneous scar from the prior Pfannenstiel incision site (P).. B. Cephalically angled view from a vertically rotating 3D movie (QuickTime, 11.5 MB) showing mass (M), subcutaneous scar (arrows) and anterior abdominal wall scar (arrowheads) from prior Pfannenstiel incision site. [PowerPoint Slide]
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Repeat CT scan of the pelvis (Figure 2, Figure 3) now demonstrated a 9.4 x 2.3 cm dumbbell-shaped right lower quadrant mass in contact with the psoas muscle, and extending through the abdominal wall into the overlying subcutaneous tissue.
Axial T1-weighted image of lower abdomen, showing dumbbell-shaped right lower quadrant mass adjacent to the psoas muscle, extending through the abdominal wall into the overlying subcutaneous tissue. [PowerPoint Slide]
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Coronal T1-weighted (A) and STIR (B) images of anterior abdomen, demonstrating mass (M) herniating through anterior abdominal wall at the lateral margin of the Pfannenstiel incision (arrows). [PowerPoint Slide]
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A thin well-demarcated capsule surrounding the lesion demonstrated increased signal intensity on short-tau inversion recovery (STIR) and decreased signal intensity on T1-weighted MRI (Figure 5).
Gross photograph of the excised mass shows a large, lobulated lesion surrounded by a thin, well-vascularized and fibrous pseudocapsule. [PowerPoint Slide]
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The pathologic specimen had a maximal diameter of 16 cm (Figure 6).
Photomicrographs of the tumor with hematoxylin and eosin stain.. A. Low power photomicrograph of the tumor showing an admixture of mature adipose tissue and benign-appearing spindle cells with brightly eosinophilic cytoplasm. [PowerPoint Slide]. B. High power photomicrograph showing cytologic features of spindle cell proliferation. These spindle cells have elongated nuclei with tapered ends and abundant eosinophilic cytoplasm. [PowerPoint Slide]
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On histologic examination (Figure 7, Figure 8), the mass was composed of fascicles of benign appearing spindle cells admixed with mature adipose tissue.
High-power microscopic section of the tumor with immunohistochemical stain for desmin. The brown areas shown here denote lesional cells which are diffusely and strongly positive for desmin. Similar lesional cells were also diffusely and strongly positive for smooth muscle actin (not shown). [PowerPoint Slide]
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On histologic examination (Figure 7, Figure 8), the mass was composed of fascicles of benign appearing spindle cells admixed with mature adipose tissue. On immunohistochemical studies (Figure 8), spindle cells were diffusely and strongly positive for smooth muscle actin and desmin.