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case_images: (a) Hematoxylin and eosin (H&E) stain at 4x magnification showing soft tissue mass with pale eosinophilic amorphous deposits of material with associated multinucleated giant cells (arrow). (b) H&E stain at 10x magnification showing a vessel (arrowhead) with perivascular amyloid deposition (arrow).
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case_images: She underwent wide local excision and the histopathology showed abundant eosinophilic material with associated lymphoplasmacytic infiltration (Figure 1).
case_images: (a) Congo Red stain at 20x showing "apple green" birefringence characteristic of amyloid (arrow). (b) Immunohistochemistry showing staining positive for amyloid P (arrow). (c) Immunohistochemistry showing staining positive for amyloid A (arrow).
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case_images: The cells were positive for amyloid P, amyloid A, but inconclusive for kappa and lambda light chains (Figure 2).
case_images: Axial view of MRI of the left lower extremity showing subcutaneous nodular lesion (red arrow) with post-contrast enhancement (blue arrow).. Abbreviation: MRI, magnetic resonance imaging.
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case_images: Magnetic resonance imaging (MRI) confirmed the recurrence of the previous tumor (Figure 3).
case_images: Axial view of MRI of the left lower extremity showing multiple subcutaneous nodular lesions (red arrow) with post-contrast enhancement (blue arrow).. Abbreviation: MRI, magnetic resonance imaging.
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case_images: The MRI of the left leg showed at least 4 new enhancing lesions concerning for recurrence of recurrence (Figure 4).
case_images: (a) PET scan showing hypermetabolic uptake in bilateral lower extremities (blue arrows). (b) MIP image of PET scan identifying numerous hypermetabolic lesions in bilateral lower extremities (red arrow).. Abbreviations: MIP, maximum intensity projection; PET, positron emission tomography.
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case_images: The PET scan also showed a new hypermetabolic area medial to the left knee with no other hypermetabolic activity elsewhere (Figure 5).
case_images: MIP image of a whole body PET scan identifying numerous hypermetabolic lesions in bilateral lower extremities, left more than right side (red arrow). No evidence of any other hypermetabolic areas was noticed.. Abbreviations: MIP, maximum intensity projection; PET, positron emission tomography.
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case_images: The PET-CT showed multiple bilateral lower extremity hypermetabolic lesions with a dominant left side lesion (Figure 6).
case_images: MIP image of whole body PET scan showing improvement in the previously noticed hypermetabolic lesions in bilateral lower extremities (red arrows).. Abbreviations: MIP, maximum intensity projection; PET, positron emission tomography.
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case_images: Repeat PET scan after 2 cycles of bortezomib and dexamethasone showed improvement in the previous hypermetabolic lesions (Figure 7).