Abstract
A 63-year-old male was found to have a 7.5-cm splenic mass that had imaging appearances of an atypical haemangioma on CT, ultrasound and a 99mTc-RBC scan, and he was followed conservatively with serial ultrasounds. Sixteen months later, however, the splenic lesion grew and he developed numerous new liver masses which were biopsy confirmed to be a pleomorphic spindle cell sarcoma (PSCS), formerly known as malignant fibrous histiocytoma (MFH). A staging 18F-FDG PET/CT was performed and showed innumerable, mostly necrotic hepatic and splenic masses. The patient passed away a few days after the PET/CT, before a treatment program could be implemented. The use of 18F-FDG PET/CT in the staging of splenic PSCS has not been previously described. We present the 99mTc-RBC and 18F-FDG PET/CT image characteristics of a patient with splenic PSCS.
Highlights
A core biopsy of the liver showed polymorphic atypical proliferation of poorly differentiated cells associated with coagulated necrosis and a sprinkling of small lymphocytes with eosinophils
HMB-45, lysozyme, myeloperoxidase, podoplanin, CD20 and muscle specific A (Figure 5). These findings were consistent with pleomorphic spindle cell sarcoma (PSCS, previously known as malignant fibrous histiocytoma, MFH)
Splenic haemangiomas have been described to show delayed-phase contrast enhancement in a mottled pattern rather than a centripetal fill-in pattern which is commonly seen in liver haemangiomas.[2]
Summary
A core biopsy of the liver showed polymorphic atypical proliferation of poorly differentiated cells associated with coagulated necrosis and a sprinkling of small lymphocytes with eosinophils. A follow-up ultrasound showed an increase in the size of the splenic mass and new liver lesions.
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