case_images: PMC11625112_01
case_images: Axial non contrast (A), arterial Dual Energy Iodine Water (B, arrow) and portal phase contrast (C) pelvic computed tomography, show a voluminous, polylobulated, solid mass with smooth margin (yellow arrow), between bladder (with a catheter) and rectum in the median-paramedian bilateral area but prevalent on the right, well-limited, with regular margins, homogeneously hypodense and with mild contrast enhancement prevalent in portal phase.
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case_images: CT multiphase protocol was performed (noncontrast, arterial, corticomedullary, parenchymal, and excretory phases) with intravenous contrast (1.0-1.5 mL/kg injected at 3.5 mL/s, followed by 50 mL of a saline bolus injection). CT after contrast revealed a large irregular solid mass with smooth margin in the Douglas' pouch (Fig. 1), with no signs of tumor invasion, the fat planes and the rectus-vescical cleavage were normal.
case_images: Axial Pelvic MRI T2-w with (A, arrow) and without (B) fat suppression, T1-w fat saturation (C) and DWI with ADC map (D-E), show a slight inhomogeneity of the lesion, that exhibit an hypointensity on T2, an hypointensity on T1 and a restriction of diffusion.
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case_images: T2-weighted (T2-w) images and the lack of an origin from the main peritoneal organs (Figs. 2, 3).
case_images: Sagittal (A, arrow) and coronal (B) Axial Pelvic MRI T2-w, reveal relationship with the main solid and hollow peritoneal organs, from which it does not originate.
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case_images: T2-weighted (T2-w) images and the lack of an origin from the main peritoneal organs (Figs. 2, 3).
case_images: Ematossilina-eosina staining 10x (A): Bundles of spindle cells intertwined each other's (so called storiform pattern), 40x (B) The stromal cells appear as well differentiated cells with central nucleus and eosinophilic cytoplasm, 40x (C) Clusters of lymphocytes and mast cells are present among stromal cells, 20x (D) Sclerotic and hyaline regressive area totally acellular.
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case_images: The histological picture was characterized by a proliferation of stroll spindle cells organized in bundles intertwined with each other (Fig. 4A) with a clearly visible central nucleus and eosinophilic cytoplasm (Fig. 4B). Mixed with the stroll population were aggregates of lymphocytes and mast cells (Fig. 4C), and focally regressive areas were observed with the formation of acellular sclerotic hyaline bands (Fig. 4D).