case_images: PMC10908280_01
case_images: (A) Abdominal and pelvic CT scan reveals multiple nodules and masses present on the liver capsule (red arrow), (B) the largest lesion measuring approximately 87mm x 53mm and located in the mid-abdomen (red arrow), (C-F) there are also multiple nodules and mass lesions within the abdominal cavity (red arrow).
case_images: OTT-17-163-g0001.jpg
case_images: PMC10908280_01_OTT-17-163-g0001.jpg
case_images: f0001
case_images: Enhanced CT showed multiple nodules and masses in the abdominal cavity and hepatic capsule, multiple enlarged lymph nodes in the bilateral diaphragmatic angle, retroperitoneum, bilateral iliac vessels, and multiple bone metastases (Figure 1).
case_images: The pictures of tumor pathology sections: (A) HEx10, (B) HEx20, (C) EMA +, (D) vim +. (E) NGS of primary abdominal tumors showing WT-EWSR1 rearrangement. Burning Rock Dx, OncoScreen Plus Panel (Contains 520 genes).
case_images: OTT-17-163-g0002.jpg
case_images: PMC10908280_01_OTT-17-163-g0002.jpg
case_images: f0002
case_images: CT-guided puncture biopsy of the lower abdominal mass was performed, and the pathology results indicated DSRCT (Figure 2). NSE, CD99 and CK (pan), and next-generation sequencing (NGS) of the tissue samples showed a TERT gene promoter region mutation (C.-263g > A) and EWSR1 rearrangement (WT1-EWSR1) (Figure 2). No genetic abnormalities were seen on the NGS of the blood samples (Burning Rock Dx, OncoScreen Plus Panel).  
case_images: (A) Before chemotherapy, CT scan reveals abdominal masses (red arrow), (B,C) after 2 cycles of chemotherapy, abdominal masses was shrinking (red arrow), (D) after 5 cycles of chemotherapy, enlarged lesions next to the left iliac vessels (red arrow), (E) 1 month after radiotherapy, the lesions decreased (red arrow), (F) 3 months after radiotherapy, the lesions decreased further (red arrow).
case_images: OTT-17-163-g0003.jpg
case_images: PMC10908280_01_OTT-17-163-g0003.jpg
case_images: f0003
case_images: However, after the fourth and fifth cycles of IE, CT re-evaluation suggested enlarged lesions next to the left iliac vessels, whereas the remaining lesions in the abdominal cavity and multiple swollen lymph nodes decreased in size (Figure 3). CT reexamination one month later revealed a decrease in the size of multiple nodules and masses in the abdomen and pelvis (Figure 3), slightly shrunken multiple nodules in the liver capsule, and no changes in the retroperitoneal and iliac vascular lymph nodes.
case_images: (A) Progressive increase in absolute monocyte count, (B) bone marrow cytology: significant increase in immature monocytes, (C) Karyotype:46, XY, t (11:19) (q23;p13)[19]/46, XY[1].
case_images: OTT-17-163-g0004.jpg
case_images: PMC10908280_01_OTT-17-163-g0004.jpg
case_images: f0004
case_images: However, the absolute monocyte count increased progressively in April 2021 (Figure 4). Bone marrow cytology, biopsy, and flow cytometry immunophenotyping suggested acute myeloid leukemia-M5 (AML-M5) (Figure 4). Karyotype analysis of the bone marrow cells showed translocation between chromosomes 11 and 19 (Figure 4).