Methods
Due to severe abdominal pain the patient referred to us as gynecologic
oncology specialists, then in November 2023, she was subjected to open
laparotomy. We detected multi nodular solid mass on laparotomy that
involved intestinal wall, omentum (figure 3A), small intestine
especially near the ileocecal junction, appendix, recto-sigmoid region
and pancreas. The general surgeon excised omentom then sample was sent
to frozen section and histological analysis. High grade metastatic
sarcoma was reported. A total hysterectomy with bilateral
salpingo-oophorectomy, pelvic tumor
resection and appendectomy were
performed; also the celiac plexus blocked, then samples referred to
pathology assessments (Figure 3), tissues specimens included the uterus,
fallopian tubes, the vermiform appendix, peritoneal fluid sample and
multiple lesions on the bowel. Pathology report confirmed high grade
sarcoma on surface of right ovary, appendix, and isolated mass from the
gut, also abdominal fluid suggesting malignant peritoneal effusion. The
Hematoxylin-Eosin (H&E) staining of samples revealed cell
proliferation, strong intensity nuclear staining, and evident nuclear
atypia (Figure 3B,C). In the histopathology report of the hysterectomy
specimen, no obvious abnormalities of uterine wall and endometrium
reported. Immunohistochemical analysis showed positive result for smooth
muscle desmin (Figure 3D) but negative for CD117, CK7, CDX2 and
Caldesmon. Weakly positive immune reaction for Actin and CK also
reported.