Malignant small round cell tumor
Presented with complaints of joint pain radiating to bilateral lower limb since 2-3 months. Also presented with abdominal tenderness and distension since 2-3 days, decreased appetite since 3 days.
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CECT abdomen and pelvis revealed an ill-defined heterogeneously enhancing mass lesion in the pelvis on left side involving the floor of the pelvis and neurovascular bundle on left side. This is seen infiltrating the rectus muscle, iliopsoas muscle and ureter on left side.
Mild left hydroureteronephrosis with delayed excretion of contrast noted.
Urinary bladder – wall is diffusely thickened with perivesical fat stranding and shows heterogenous enhancement on post contrast study.
Multiple preaortic and mesenteric lymph nodes noted with minimal ascites.
Mild hepatomegaly with delayed target like enhancing lesions in both lobes of liver - likely metastases.
Multiple peritoneal nodules noted in the subhepatic and left hypochondriac region.
Patient underwent liver biopsy under ultrasound guidance.
Microscopy – Sections shows tumor tissue composed of monotonous population of cells arranged in diffuse sheets, separated by thin fibrovascular septae. These cells have small to medium sized hyperchromatic nuclei with scant cytoplasm. Occasional nuclear molding noted. Scattered mitotic figures and apoptotic bodies seen. Few eosinophils noted. Adjacent normal liver tissue shows fatty change and mixed inflammatory cells.
Impression – Features suggestive of metastasis from malignant small round cell tumor.