case_images: PMC11573832_01
case_images: T2-weighted (a), PD-weighted (b), and contrast-enhanced T1-weighted (c) MRI images, illustrating a diffuse abnormal signal intensity in all muscles of the lower leg with band-like appearances at the periphery of the involved muscles. Additionally, there is a diffuse subcutaneous infiltration and thickening of the cutis. The fused PET\CT image (d) reveals increased FDG uptake in the same muscles, once again exhibiting a band-like peripheral orientation
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case_images: PMC11573832_01_256_2024_4680_Fig1_HTML.jpg
case_images: Fig1
case_images: Additionally, there was associated subcutaneous stranding and skin thickening (Figs. 1 and 2).
case_images: Pre-contrast (a) and post-contrast (b) T1-weighted MRI images, depicting band-like enhancement at the periphery of the muscles involved in the lower leg
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case_images: PMC11573832_01_256_2024_4680_Fig2_HTML.jpg
case_images: Fig2
case_images: Additionally, there was associated subcutaneous stranding and skin thickening (Figs. 1 and 2).
case_images: a (top) Fused FDG PET\CT images of the lower legs in the axial plane, revealing a noticeable difference in size between. There is significant swelling in the right lower leg, accompanied by increased FDG uptake in both the affected muscles and subcutaneous tissues. b (bottom) Fused FDG PET\CT images of the lung showing multiple lung lesions
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case_images: Fig3
case_images: A whole-body FDG positron emission tomography/computed tomography (PET/CT) scan showed elevated FDG uptake in the right lower leg, displaying a band-like appearance with heightened uptake in the peripheral region (Fig. 3a). Multiple FDG-positive lung lesions were observed, raising suspicion of metastatic disease (Fig. 3b).
case_images: PMC11573832_02
case_images: Pre-amputation (a) and post-amputation (b) maximal intensity projection of FDG uptake. Within just 1 month, there is a pronounced progression of the disease, evidenced by a robust increase in FDG uptake in the pulmonary, lymph nodes, peritoneal, and muscle regions
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case_images: Fig4
case_images: A post-amputation FDG PET-CT scan demonstrated a substantial progression of the disease, characterized by increased FDG uptake in multiple pulmonary masses, thoracic and abdominal lymph nodes, and diffuse heightened peritoneal FDG uptake (Fig. 4).
case_images: Histological slides of the lung lesion biopsy. The a HE staining shows the lesional cells in the mid-right with large, irregular nuclei, positive for b CD2, c EBER, d CD30, and e granzyme B staining
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case_images: Fig5
case_images: The atypical population was EBER (Epstein-Barr virus-encoded small RNA's)) and CD30 positive and showed positivity for some T cell markers (CD2, CD3, and CD7), but also the NK marker granzyme B (Fig. 5).