case_images: PMC9593107_01
case_images: (A and B) Images of abdominal CT with contrast showing a solid expansive image (arrows) with regular contours and slight post-contrast enhancement in the left pelvic cavity and iliac fossa. CT: Computed tomography
case_images: RJME-63-1-191-fig1.jpg
case_images: PMC9593107_01_RJME-63-1-191-fig1.jpg
case_images: F1
case_images: Abdominal contrast-enhanced computed tomography (CT) (July 12, 2019) showed a solid expansive image with regular contours and slight post-contrast enhancement in the left pelvic cavity and iliac fossa, measuring 5.8x5.3x4.7 cm (Figure 1).
case_images: (A and B) Images of abdominal and pelvic MRI study revealing a heterogeneous solid mass in the anterior wall of the left iliac fossa (arrows), with intense post-contrast enhancement and displacement of intestinal loops. MRI: Magnetic resonance imaging
case_images: RJME-63-1-191-fig2.jpg
case_images: PMC9593107_01_RJME-63-1-191-fig2.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) of the abdomen and pelvis (September 22, 2019) revealed a heterogeneous solid mass in the anterior abdominal wall of the left iliac fossa, measuring approximately 6.3 cm, with intense post-contrast enhancement displacing the intestinal loops, and lymph node enlargement in the external iliac chain on the left (Figure 2).
case_images: Video laparoscopic view of the intra-abdominal mass appearing loosely adhered to peritoneum (A); images of the abdominal cavity after resection of the posterior aponeurosis of the rectus abdominis muscle (B and C); and gross aspects of the removed surgical specimen (D and E)
case_images: RJME-63-1-191-fig3.jpg
case_images: PMC9593107_01_RJME-63-1-191-fig3.jpg
case_images: F3
case_images: The direct exam of the intra-abdominal mass by video laparoscopy (February 19, 2020) showed it loosely adhered to the peritoneum (Figure 3A) and in close contact with the lower epigastric vessels. The resection of the posterior aponeurosis of the rectus abdominis muscle and the clipping of the lower epigastric vessels were performed after the opening of the peritoneum with safety margins (Figure 3, B and C). The surgical specimen (Figure 3, D and E) was removed by enlarging the umbilical incision and the anatomopathological study characterized a poorly differentiated fusocellular malignancy with 10 mitoses/10 high-power fields (HPFs) (Figure 4).
case_images: (A-C) Photomicrography of the surgical tumor sample consistent with a poorly differentiated fusocellular tumor, which presented 10 mitoses/10 HPFs. HE: Hematoxylin-Eosin; HPFs: High-power fields
case_images: RJME-63-1-191-fig4.jpg
case_images: PMC9593107_01_RJME-63-1-191-fig4.jpg
case_images: F4
case_images: The surgical specimen (Figure 3, D and E) was removed by enlarging the umbilical incision and the anatomopathological study characterized a poorly differentiated fusocellular malignancy with 10 mitoses/10 high-power fields (HPFs) (Figure 4). The IHC evaluation showed positivity for pan-cytokeratin (CK) AE1/A3, B-cell lymphoma 2 (Bcl-2), calretinin, cluster of differentiation (CD)56, CD99 (focal), Ki67 (in 1% of cells), and CD34 (in vessels); and negativity for CD34 and CK7 in tumor cells (Figure 4).