case_images: PMC4065691_01
case_images: Left perineal mass. Examination of the vagina reveals a bulging mass through the left wall of the vagina but without any direct invasion. Examination of the rectum revealed normal tone with displacement of the left lateral rectal wall towards the midline.
case_images: CRIS2014-629672.001.jpg
case_images: PMC4065691_01_CRIS2014-629672.001.jpg
case_images: fig1
case_images: A 40-year-old African American, morbidly obese female patient was referred to our service for evaluation of left buttock mass (Figure 1).
case_images: MRI sagittal plane. 23 cm (craniocaudal) mass exhibits midrange T2 weighted signal superiorly with diminished T2 weighted signal at its inferior position. White arrow showing the mass abutting the posterior wall of the vagina. Dashed arrow showing the rectum wall.
case_images: CRIS2014-629672.002.jpg
case_images: PMC4065691_01_CRIS2014-629672.002.jpg
case_images: fig2
case_images: The MRI dimensions of the mass were 23 x 8 x 11 cm and showed no muscular or osseous invasion, with well-defined walls and considerable enhancement with a preliminary diagnosis of a pedunculated leiomyoma; however, a soft tissue sarcoma could not be ruled out (Figure 2).
case_images: Resected mass measuring 24 x 12 x 8 cm with smooth tan-pink surface and weighting 1660 gm. On sections, the mass shows areas of smooth, whorled tan-white tissue, with areas of cystic degeneration, edema, and rare slightly softer, white opaque areas. No hemorrhage or necrosis is identified grossly.
case_images: CRIS2014-629672.003.jpg
case_images: PMC4065691_01_CRIS2014-629672.003.jpg
case_images: fig3
case_images: During surgery, an ellipsoid well-circumscribed mass measuring 24 x 12 x 8 cm was noted without invasion to surrounding tissue (Figure 3).
case_images: Hematoxylin-eosin staining of tumor section showing well-differentiated smooth muscle cells with eosinophilic cytoplasm and bland, blunt-ended nuclei (40x).
case_images: CRIS2014-629672.004.jpg
case_images: PMC4065691_01_CRIS2014-629672.004.jpg
case_images: fig4
case_images: These cells had eosinophilic cytoplasm and mostly bland, uniform, cigar-shaped nuclei, resembling normal smooth muscle cells (Figure 4).
case_images: Morphology and Immunohistochemical staining of tumor; HE: hematoxylin-eosin, HEX10 (low power field), HEX40 (high power field), Desmin (positive), SMA: smooth muscle actin (positive), ER: estrogen receptor (positive), PR: progesterone receptor (positive), CD34 (negative), and CD117 (negative).
case_images: CRIS2014-629672.005.jpg
case_images: PMC4065691_01_CRIS2014-629672.005.jpg
case_images: fig5
case_images: Immunohistochemistry showed that these tumor cells were positive for desmin, smooth muscle actin, estrogen receptor, and progesterone receptor and negative for S100, CD117, and CD34, confirming the smooth muscle origin of the tumor (Figure 5).