A Rare Presentation of a Large Pleomorphic Rhabdomyosarcoma of the Inferior Vena Cava (IVC): A Case Report

Figures

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  Figure 1. CT IVP delayed phase pre-operatively CT: computed tomography; IVP: intravenous pyelogram; IVC: inferior vena cava (a) Axial image demonstrating a 53 x 39 x 60 mm lobulated mass (red arrow) along the course of the right ureter (yellow arrow) with likely local invasion of the right anterior margin of the psoas muscle (blue arrow). (b) Coronal slice demonstrating the lobulated mass (red arrow) invading the IVC lumen (blue arrow)

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  Figure 2. CT portal venous phase pre-operatively CT: computed tomography; IVC: inferior vena cava (a) Axial slice demonstrating an interval increase in size of the right retroperitoneal mass (red arrow) to 69 x 73 x 71 mm lying in proximity to the right ureter (yellow arrow) and IVC (blue arrow). (b) Coronal slice demonstrating the lobulated mass (red arrow) invading the IVC lumen (blue arrow)

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  Figure 3. MRI T2 phase pre-operatively MRI: magnetic resonance imaging; IVC: inferior vena cava (a) Coronal slice demonstrating a right-sided malignant tumour (red arrow) with involvement of the third part of the duodenum (yellow arrow). (b) Axial slice demonstrating a lobulated mass (red arrow) invading the IVC lumen (yellow arrow) with involvement of right ureter (green dotted oval), and right psoas (blue arrow)

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  Figure 4. a-b showing fused PET-CT phase pre-operatively PET: positron emission tomography (PET); CT: computed tomography; IVC: inferior vena cava (a) Axial slice demonstrating a right retroperitoneal mass (red arrow) with central photopenia and peripheral moderate to high-grade increased activity extending to the right psoas muscle (blue arrow), duodenum (green dotted oval), and IVC (yellow arrow). (b) Coronal slice demonstrating right retroperitoneal mass (red arrow) with activity extending to the right psoas muscle (blue arrow)

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  Figure 5. a-d shows macroscopic and microscopic findings of the tumour H&E: hematoxylin and eosin; MyoD1: myogenic differentiation 1 gene (a) Macroscopic image of the en bloc resection measuring overall dimensions 300 x 170 x 110 mm with tumour size of 90 x 60 x 60 mm. (b) H&E staining showing cellular population of large, rounded epithelioid, rhabdoid, plump spindled and bizarre multinucleate tumour giant cells occurring in sheets. (c) Immunohistochemistry showing extensive staining of the atypical tumour cells for desmin. (d) Immunohistochemistry showing extensive staining of the atypical tumour cells for MyoD1 with multifocal coexpression of myogenin

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  Figure 6. a-d showing MRI T2 phase six months post-operatively a: Coronal slice demonstrating a lesion within the inferior aspect of segment 3 of the liver (red arrow) measuring 8.4 x 5.9 x 9.5 cm (1 = 9.5cm). (b) Axial slice demonstrating a lesion within the inferior aspect of segment 3 of the liver (red arrow). (c) Axial slice showing suspicious recurrence within resection bed (red arrow) intimately related to reconstructed IVC (yellow arrow). (d) Axial slice showing right lung base lesion (white arrow) (1 = 1.36cm)