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case_images: Computed tomography scan. Computed tomography scans showed an enlarged retroperitoneal lymph node of the posterior inferior vena cava (A) and rapidly enlarged lymph node after chemotherapy (B).
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case_images: About 29 months after gastrectomy, CT imaging was performed and revealed a solitary localized mass measuring 43 mm in diameter among the retroperitoneal lymph nodes of the posterior inferior vena cava (IVC) (Fig. 1A). However, a follow-up CT scan indicated that the tumor rapidly enlarged (59 mm); no new lesions were observed (Fig. 1B).
case_images: Macroscopic finding. Grossly, the tumor was hard and fibrotic, measuring 66 x 58 x 50 mm. The cut surfaces were multinodular, diffusely edematous, and myxoid with focal petechial hemorrhagic necrosis (approximately 15%) and fish-flesh appearance.
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case_images: The cut surfaces were multinodular, diffusely edematous, and myxoid with focal petechial hemorrhagic necrosis (approximately 15%) and had a fish-flesh appearance (Fig. 2).
case_images: Histological examination of biopsy. (A) pleomorphism with bizarre multinucleated tumor cells and high frequency mitosis (hematoxylin and eosin, x100). (B) Tumor cells showed strong reactivity for desmin (desmin, x200).
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case_images: The pathological examination showed pleomorphism with bizarre multinucleated tumor cells and an average of 19 mitoses per 10 high-power fields in the tumors (Fig. 3A). The tumor was immunohistochemically positive for smooth muscle actin (SMA), desmin, and H-caldesmon and negative for c-KIT, CD34, and S-100 (Fig. 3B).