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case_images: Cytologic examination of fine-needle aspiration. Fine-needle aspiration shows cohesive fragments consist of cells with crowding and overlapping of enlarged nuclei and indistinct cytoplasmic borders; May Grunwald-Giemsa stain, magnification x100 (A), x200 (B).
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case_images: The results, obtained two days later, revealed scant cellularity with groups of atypical cells exhibiting crowding and overlapping of nuclei, moderate cytoplasm, and indistinct cytoplasmic borders (Figure 1).
case_images: Magnetic resonance imaging (MRI) of abdomen and pelvis. Sagittal (A) and axial (B) HASTE sequence on magnetic resonance imaging (MRI) of abdomen and pelvis (like T2 weighted imaging with fat suppression) reveals enlarged left rectus abdominis muscle with ill-defined hyperintense lesion (arrow).
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case_images: Magnetic resonance imaging (MRI), performed a week later, confirmed a 2.1 x 0.9 cm focal lesion in the left RAM of unknown etiology (Figure 2).
case_images: Pathohistological microscopic examination. Pathohistological analysis of the intramuscular node shows clusters of glands and the stroma characteristics of the endometrial mucosa. In the vicinity of the gland with a dilated lumen, the stroma of the endometrium is less noticeable, next to which the remnants of striated muscle tissue can be seen (asterisk) (A). Abundant connective tissue is seen around the glands and the clearly visible stroma of the endometrium, but the transverse striated musculature is not found (B). The focus of endometriosis with the microscopic foci of fresh bleeding is surrounded by connective tissue that permeates the fibers of the striated musculature with reparative changes (C). At high magnification, the epithelium of the gland is without atypia, showing mild proliferation, and there is scarce fresh bleeding in the surrounding stroma (D). Hematoxylin and eosin stain, magnification x100 (A,B), x200 (C), x400 (D).
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case_images: Microscopic examination revealed morphologically normal endometrial stroma and glands within the skeletal muscle tissue, with positive margins (Figure 3).
case_images: Alpha-smooth muscle actin (ASMA) immunohistochemical staining. Immunohistochemical staining for ASMA shows myoepithelial cells in the basal layer of the endometrial glands, but also within the stroma (arrows), magnification x100.
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case_images: Immunohistochemical staining of inflammatory cells and blood vessels. Immunohistochemical staining using antibodies against specific cluster of differentiation (CD) molecules shows rare scattered B lymphocytes (A) and significantly more T lymphocytes (B) with a higher proportion of cytotoxic (C) than helper lymphocytes (D). Macrophages were present in a smaller percentage than T lymphocytes (E), while the stroma of endometriotic foci shows blood vessel proliferation (F); (A) CD20; (B) CD3; (C) CD8; (D) CD4; (E) CD68; (F) CD31; magnification x100.
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case_images: Anterior abdominal wall ultrasound examination. An ultrasound examination of the anterior abdominal wall with a linear 15 Hz probe 5 years after resection with minimal scarring (arrow) of the left rectal muscle without signs of recurrence.
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case_images: After 6 years of follow-up, the patient remains symptom-free and has shown no recurrence of the disease (Figure 6).