Malignant small round cell tumor

Case contributed by Dr Akshit Aiyappa M J

Presentation

Presented with complaints of joint pain radiating to lower limbs for past 2-3 months. Also presented with abdominal tenderness and distension for past 2-3 days and decreased appetite for past 3 days.

Patient Data

Age: 40 years
Gender: Female

CECT abdomen and pelvis revealed an ill-defined heterogeneously enhancing mass lesion in the left pelvis involving the pelvic floor and left neurovascular bundle. The mass infiltrates the left rectus abdominis muscle, iliopsoas muscle and ureter.

Mild left hydroureteronephrosis with delayed excretion of contrast noted.

The urinary bladder wall is diffusely thickened with perivesical fat stranding and shows heterogenous enhancement on the post-contrast study.

Multiple pre-aortic 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.

Case Discussion

Patient underwent liver biopsy under ultrasound guidance.

Microscopy – Sections show 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.

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