PMC6925941_01
(a) Hypoechoic mass lesion on ultrasound image. (b) Strip-like blood flow signal of the mass on color Doppler flow image.
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fig1
The ultrasound images depicted multiple, solid, hypoechoic mass lesions in pelvis (Figure 1(a)). Color Doppler flow imaging (CDFI) showed strip-like blood flow signal (Figure 1(b)). The pelvic nodules were composed of close-arranged spindle cells which were featured by nuclear enlargement, pleomorphism and atypia (Figure 1(a)).
(a) Multiple lobulated, intermediate intensity lesions in T1W image. (b) Intense enhancement of the lesions following contrast administration in T1W image.
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fig2
T1W images (Figure 2(a)). These lesions showed intense enhancement on post enhancement images (Figure 2(b)).
(a) The largest mass on the surface of retroperitoneum. (b) The gross appearance of the larger two lesions.
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fig3
These nodules scattered located on the surface of retroperitoneum, sigmoid colon and urinary bladder (Figure 3(a)). All the visible lesions were excised including two biggest nodules on retroperitoneum and sigmoid colon (Figure 3(b)).
(a) HE staining of the sample under microscope (magnification: 200x). The arrow refers to atypical spindle cells. (b) The positive result of immunohistochemistry of desmin, which is a specific protein of muscle cells.
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fig4
On immunohistochemistry, the cells are positive for specific smooth muscle proteins: Desmin[+] (Figure 4(b)), SMA[+], Caldesmon[+].