case_images: PMC5367224_01
case_images: (a) Ultrasound showing a mixed echogenicity mass in the pelvis. (b) Cut section of the retroperitoneal nodule showing gray-white whorled appearance
case_images: JMH-8-45-g001.jpg
case_images: PMC5367224_01_JMH-8-45-g001.jpg
case_images: F1
case_images: There was no free fluid in the pouch of Douglas [Figure 1a]. Grossly, the retroperitoneum, left ovary, and mesenteric nodules were gray-white, homogenous in appearance, the cut section showed a whorled gray-white appearance [Figure 1b].
case_images: (a) Photomicrograph showing whorls and fascicles of smooth muscle cells along with myxoid and cystic change (H and E, x100). (b) Photomicrograph showing red and blue taken up by smooth muscle and hyalinized areas, respectively (Massons trichome, x400). (c) Photomicrograph showing smooth muscle actin positivity in smooth muscle cells (IHC, x400)
case_images: JMH-8-45-g002.jpg
case_images: PMC5367224_01_JMH-8-45-g002.jpg
case_images: F2
case_images: Histology revealed similar findings from the retroperitoneum, left ovary, and mesenteric masses; interlacing and intersecting fascicles of smooth muscle cells arranged in whorls and having an abundant eosinophilic fibrillar cytoplasm with focal myxoid and cystic change were appreciated [Figure 2a]. On Masson trichome stain, the smooth muscle cells stained red and the hyalinized areas were blue [Figure 2b]. The smooth muscle cells were positive for smooth muscle actin (SMA) on immunohistochemistry [Figure 2c].