case_images: PMC11390231_01
case_images: Radiology and gross tumor examination. (a) T2 magnetic resonance imaging (MRI) shows extensive venous thrombus extending from the right internal iliac vein to the right atrium, representing tumoral thrombosis or an intravenous mass inferiorly with transition into bland thrombus at the level of the intrahepatic inferior vena cava (IVC). (b) A gross examination of the mass measures around 10 cm.
case_images: CRIPA2024-4073869.001.jpg
case_images: PMC11390231_01_CRIPA2024-4073869.001.jpg
case_images: fig1
case_images: The restriction and enhancement become subtle at the level of suprarenal IVC with a lack of diffusion restriction at suprahepatic IVC and right atrium (Figure 1(a)). The resected mass was sent for histopathology examination which grossly measured around 10 cm in maximum dimension (Figure 1(b)).
case_images: Histopathology examination of the tumor by hematoxylin and eosin (H&E) stains. (a) Tumor section taken from the primary surgical resection (original hysterectomy specimen) that shows bland spindle cell proliferation with whorling around small blood vessels (H&E; 20x). (b) Microscopic evaluation of metastatic LGESS with a focal area of differentiation formed as a distinctive nodule (note the sharp demarcation) (H&E; 2x). (c) Focal areas of the tumor composed of cellular and compact branching cords and trabeculae of tumor cells representing sex cord-like differentiation (H&E; 20x). (d) Clusters of epithelioid cells arranged in glandular-like differentiation with variable cytoplasmic amount, round nuclei, and minute nucleoli arranged in tubules (H&E; 20x). Note the occasional nuclear groove (inset) (H&E; 40x).
case_images: CRIPA2024-4073869.002.jpg
case_images: PMC11390231_01_CRIPA2024-4073869.002.jpg
case_images: fig2
case_images: Interestingly, one microscopic focus shows a well-demarcated, more cellular area composed of compact tumor cells with nested growth patterns, exhibiting both features of glandular- and sex cord-like differentiation (Figure 2).
case_images: Tumor examination by confirmatory immunohistochemistry studies. (a) Tumor cells are strongly immunoreactive for CD10 (expressed in both conventional areas and areas of glandular differentiation) (40x). (b) The tumor cells show strong positivity for WT1 (40x). (c) Clear nuclear positivity for estrogen receptor (expressed in both conventional areas and areas of glandular differentiation) (40x). (d) The tumor cells are completely negative for Cyclin-D1 immune staining (40x).
case_images: CRIPA2024-4073869.003.jpg
case_images: PMC11390231_01_CRIPA2024-4073869.003.jpg
case_images: fig3
case_images: ESS cells were strongly reactive for CD10, WT1, estrogen receptor (ER), and progesterone receptor (PR), while totally negative for Cyclin-D1 (Figure 3). Extensive tissue sampling and regrossing of the specimen reveal no other foci of differentiation.