PMC9975949_01
(a) Ultrasonic image: mass in the left retroperitoneum with an irregular shape and uneven internal echo. (b) Ultrasonic image: the CDFI shows no blood flow signal of the mass.
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The left posterior peritoneum, which was at the height of the left renal artery and abdominal aorta, had an irregularly shaped hypoechoic area (4.3 cm x 4.8 cm x 3.6 cm) with a non-uniform internal echo (Figure 1a). The color doppler flow imaging (CDFI) revealed the internal blood flow to be non-abundant (Figure 1b).
(a) Computed tomography (CT) cross section: low-density area of soft tissue mass in the front edge of the left retroperitoneal psoas major muscle. (b) The CT sagittal plane: low-density area of soft tissue mass in the front edge of the left retroperitoneal psoas major muscle.
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The abdominal CT imaging revealed that the anterior edge of the left psoas major muscle was occupying some space, and the possibility of schwannoma (Figure 2a and b) was considered.
MRI T2WI cross section: quasi-circular abnormal signal area in the left front of the second and third lumbar vertebrae. The T2WI signals were mixed and had uneven enhancement.
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Magnetic resonance imaging (MRI) of the lumbar spine indicated that the tumor was at the height of the neurogenic lesions of the left front of the L2-L3 vertebral body (Figure 3).
(a) Image of gross specimen: most of the left retroperitoneal tumors are grayish yellow and necrotic. (b) Histopathological image: the left retroperitoneal mass is a malignant tumor with necrosis. Tumor cells are epithelioid, with obvious cell atypia, and mitotic images are easy to visualize (hematoxylin and eosin stain x 200). (c) Immunohistochemical tumor CD31 (+). (d) Immunohistochemical tumor cell ERG (+).
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The surgical section of the mass was smooth, with a grayish-yellow necrotic area and a local grayish-white (Figure 4a). The tumor cells were epithelioid cells with obvious cytoatypia and clear mitosis (Figure 4b). The antigen Ki-67 index was approximately 50% (Figure 4c and d).