case_images: PMC11345641_01
case_images: Imaging findings before the first operation: (A-C) Pelvic MRI revealed a tumor measuring approximately 9.9x12.0x12.6 cm in the anterior wall of the uterus. On T1-weighted images, the tumor was isointense with areas of hyperintensity. T2-weighted and fat-suppressed images showed hypointensity with areas of hyperintensity.
case_images: fonc-14-1434720-g001.jpg
case_images: PMC11345641_01_fonc-14-1434720-g001.jpg
case_images: f1
case_images: The MRI suggested degeneration of the leiomyomas, possibly indicating a cellular leiomyoma ( Figure 1 ). Microscopic examination post-surgery revealed the mass to be a leiomyoma, with most areas infarcted and some showing bizarre nuclei and rare mitotic figures (0-1/10 HPF) ( Figure 3 ).
case_images: General view after the first operation. The fragmented uterus measured 15x9x4 cm. Between the muscle layers, two grayish-white nodular masses ranging from 1.5 to 3 cm in diameter were identified. These masses had tough, vortex-like textures upon sectioning. Additionally, a cluster of cylindrical tissue, grayish-white to grayish-red in color and measuring 20x20x2 cm, was discovered. This tissue was slightly tough in consistency, with a similar grayish-white to grayish-red appearance on sectioning.
case_images: fonc-14-1434720-g002.jpg
case_images: PMC11345641_01_fonc-14-1434720-g002.jpg
case_images: f2
case_images: The general picture is as follows ( Figure 2 ). Microscopic examination post-surgery revealed the mass to be a leiomyoma, with most areas infarcted and some showing bizarre nuclei and rare mitotic figures (0-1/10 HPF) ( Figure 3 ).
case_images: Light microscopic examination of the tumor post-first resection (H&E stain, 10x10) revealed spindle-shaped cells arranged in fascicles. These cells exhibited indistinct boundaries, mild nuclear atypia, and slightly coarse chromatin. Additionally, bizarre nuclei were scattered, and mitotic figures ranged from 0 to 1 per 10 high power fields. Infarction was observed in some tumor cells.
case_images: fonc-14-1434720-g003.jpg
case_images: PMC11345641_01_fonc-14-1434720-g003.jpg
case_images: f3
case_images: Microscopic examination post-surgery revealed the mass to be a leiomyoma, with most areas infarcted and some showing bizarre nuclei and rare mitotic figures (0-1/10 HPF) ( Figure 3 ).
case_images: Imaging findings prior to the second surgery: (A-C) Whole abdomen MRI: (A, B) Multiple space-occupying lesions were identified in the right lower abdomen and pelvic cavity. The largest lesion, located in the lower abdomen, measured 11.6x10.6x8.4 cm and locally protruded into the right abdominal wall, involving the right rectus abdominis muscle. It exhibited isointense and hypointense signals on T1-weighted images and a slightly hyperintense signal on T2-weighted images. (C) A mass measuring approximately 3.6x4.2x4.2 cm was observed at the vaginal stump, displaying a hypointense signal on T1-weighted and a slightly hyperintense signal on T2-weighted images.
case_images: fonc-14-1434720-g004.jpg
case_images: PMC11345641_01_fonc-14-1434720-g004.jpg
case_images: f4
case_images: Microscopic examination post-surgery revealed the mass to be a leiomyoma, with most areas infarcted and some showing bizarre nuclei and rare mitotic figures (0-1/10 HPF) ( Figure 3 ). A lesion in the right lower quadrant had penetrated the right transversus abdominis muscle, reaching the subcutaneous fat ( Figure 4 ).
case_images: (A) Light microscopic examination of the tumor post-second resection (H&E stain, 10x10) showed pleomorphic cells with indistinct boundaries. The cytoplasm varied from eosinophilic to clear. There was severe nuclear atypia, prominent nucleoli, and conspicuous mitotic figures. The immunohistochemical results of sarcoma component: (B-D) tumor cells showed positive for Vimentin (B), negative for SMA (C) and Desmin (D).
case_images: fonc-14-1434720-g005.jpg
case_images: PMC11345641_01_fonc-14-1434720-g005.jpg
case_images: f5
case_images: Microscopic examination post-surgery revealed the mass to be a leiomyoma, with most areas infarcted and some showing bizarre nuclei and rare mitotic figures (0-1/10 HPF) ( Figure 3 ). Microscopic analysis confirmed undifferentiated sarcomas in the abdominal and pelvic masses, with tumor involvement noted in the right colon, part of the ileum, mesentery and its lymph nodes, omentum, and appendix ( Figure 5 ).