PMC8387083_01
A and B - Antero-posterior and lateral plain radiographic view of the right lower extremity showing a femur with and without metallic rod and fixation screws. The ill-defined, expansile, intramedullary lytic lesions are seen involving metaphyseal and diaphyseal regions. C - Coronal fused PET/CT showing increased FDG uptake as the large skeletal lesion involving right femur and few enlarged lymph nodes along with subcutaneous and intramuscular deposits.
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His medical history included an internal fixation with a metal rod implant for femoral fracture treatment (Figure 1A). Roughly two months after the initial symptoms, the implant was removed (Figure 1B). The positron emission tomography (PET) showed increased FDG avid uptake in the right thigh, nodal and extranodal tissue, intramuscular and subcutaneous region, renal, bowel, skeletal, omental, and peritoneal region, indicating the possibility of a disseminated malignancy (Figure 1C).
Photomicrographs of the biopsy. A - Large, atypical cells seen in solid sheets showing nuclear indentation, vesicular chromatin, prominent nucleoli and moderate basophilic to eosinophilic cytoplasm (H&E; x200); B - CD3 immunostain showing membranous positivity of variable intensity (x200); C - CD20 immunostain is negative (x200), D - CD30 displays strong membranous and golgi complex immunoreactivity (x200).
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The biopsy's histology revealed large, atypical cells in solid sheets with a round to oval irregular nuclei and nuclear indentations (Figure 2A).
Photomicrographs of the biopsy. A - ALK immunostain showing diffuse positivity in both nuclear and cytoplasm (x200); B - MUM1 showing nuclear positivity (x200).
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