PMC7436348_01
Radiologic and histologic appearance of syringocystadenocarcinoma papilliferum. (a) (I) Magnetic resonance imaging showing soft tissue mass in the thoracic spine. (II) Axial computed tomography (CT) scan showing tumor invasion into the vertebrae at T4 level. (III) Axial CT scan showing tumor invasion into the vertebrae at T2 level and enlarged right axillary lymph node. (b) (I) Lymph node with metastatic tumor, H&E stain, 40x. (II) Solid and glandular structures with warty architecture, lined by poorly-differentiated epithelium, H&E stain, 100x. (III) Clusters and nests of highly pleomorphic cells with bizarre irregular nuclei and permanent nucleoli, entrapped in fibrotic stroma, consistent with carcinoma, H&E stain, 400x. (IV) Metastatic carcinoma cells are highlighted by immune-stain (right lower corner); residual uninvolved lymph node shows no immunopositivity (left upper corner), wide spectrum cytokeratin immunostain, 100x.
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One year later, his back pain reemerged, and the patient developed bilateral lower extremity weakness, prompted a repeat MRI, which demonstrated 4.7 x 5.4 x 7.5 cm3 soft tissue cystic mass at the T3 to T5 vertebral level invading the neural foramina bilaterally as well as an enlarged right axillary lymph node (Figure 1(a)). The tumor cells were immunoreactive for high molecular weight keratin (CK5/6), wide spectrum cytokeratin, and p63 immuno-stains (Figure 1(b)).
Positron emission tomography (PET) scan images 12 months after chemoradiotherapy. Hypermetabolic activity in the left paraspinal region at the level of T4-T5 (I), in the right axilla (II), and in the left sixth rib medially (III).
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However, he developed right arm pain and weakness within a year of treatment, and the repeat imaging showed an increase in size of the right axillary lymph node and stable disease in his spine (Figure 2).