case_images: PMC11424545_01
case_images: The computed tomography (CT) plain scan of the abdomen in a local community hospital in August 2023 showed a large mixed density image in the retroperitoneal space around the left kidney, with lesions protruding from the left abdominal wall at a maximum cross-section of 5.0 cm x 4.2 cm [(A), white arrow]. The lesions showed uneven moderate enhancements in the arterial phase (B). In addition, high density lithiasis was observed in the gallbladder area [(A, B) blue arrow]. A month later, the patient was treated in Zunyi Medical University. The abdominal CT plain scan showed a large mixed density shadow in the retroperitoneal space around the left kidney and prominent lesions in the left abdominal wall with a maximum cross-section of approximately 10.7 cm x 8.2 cm [(C), white arrow], which was significantly larger than the previous one. The lesions showed mild to moderate enhancements in the arterial phase (D).
case_images: fmed-11-1461749-g0001.jpg
case_images: PMC11424545_01_fmed-11-1461749-g0001.jpg
case_images: F1
case_images: Table 1. The abdominal CT examination before and after intravenous contrast media containing iodine (Figure 1) showed that the contour of the left kidney was not clear, and the surrounding space of the left kidney showed a large mixed density shadow, gas accumulation, and protrusion from the left abdominal wall; multiple lymph node enlargements could be seen in the abdominal cavity.
case_images: 18F-FDG PET/CT (A) Maximum intensity projection (MIP) was subsequently performed to further evaluate the patient's whole-body condition, and it revealed an increased uptake of radioactivity in large patches of the left abdomen (blue arrow) and one of the high metabolic non-specific lymph node uptakes (white arrow). The axial image CT (B) showed the retroperitoneal left perirenal space and highlighted an increased uptake of fluoro-18 fluorodeoxyglucose (18F-FDG) in the left abdominal wall (SUVmax30.1). [(B): CT, (D): PET, (F): fusion]. The images [(C): CT, (E): PET, (G): fusion] showed abdominal lymph nodes (black arrows), approximately 1.4 cm x 1.2 cm in size, with partial necrotic lesions and abnormal metabolic fusion, and SUVmax was 1.9.
case_images: fmed-11-1461749-g0002.jpg
case_images: PMC11424545_01_fmed-11-1461749-g0002.jpg
case_images: F2
case_images: Moreover, multiple enlarged lymph nodes with an increased 18F-FDG uptake in the abdominal cavity, mediastinum, and left axillary lymph nodes were also observed (Figure 2).
case_images: (A) A large number of spindle cells, a large number of small thin-walled blood vessels in the tumor cells, and inflammatory cell infiltration were observed in the interstitium (hematoxylin-eosin x 100). (B) Hematoxylin-eosin (magnification, x 400) showed that the mitotic images were rare. The immunohistochemical images showed that the tumor positively expressed SMA (C), vimentin (D), calponin (E), WT-1 (F), Ki-67 [(G), index 70%], and negative desmin (H) ( x 200).
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case_images: PMC11424545_01_fmed-11-1461749-g0003.jpg
case_images: F3
case_images: Under the microscope, the tumor tissue appeared grayish-red, with an abundance of fusiform cell proliferative lesions (Figure 3).