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.