Week 498: Case 2

1. Presented by Peter Illei, M.D. and prepared by Safia Salaria, M.B.B.S.

54-year-old African American female who presented with a parasagittal lesion. The patient was in her usual good health until a few months ago when she began suffering from borderline hypertension and abdominal
discomfort. This ultimately prompted an extensive work-up, including abdominal
imaging, which demonstrated a large 6 cm (per report) liver lesion. The patient underwent surgery for this lesion (images). In the subsequent months, the patient further began experiencing respiratory difficulty instigating another work-up consisting of a chest CT and a bronchoscopy for biopsy of one consistent with sarcoidosis. Per the patient, she was never placed on steroids for her new diagnosis of sarcoidosis. After being given this diagnosis, the patient underwent a whole body PET scan and MRI of the brain which demonstrated a parasagittal dural based lesion. The tumor cells are positive for vimentin, EMA and progesterone receptors (20% of tumor cells), while negative for keratin, HepPar-1, S-100, CD34, CD31, CD117, factor VIII, HMB45, inhibin, TTF-1, smooth muscle actin and estrogen receptors. The background liver is non-crirrhotic and contains multiple non-necrotizing granulomata that are negative for fungi and acid fast organisms on special stains.