PMC5566783_01
(A) Hematoxylin & eosin stain of the scalp lesion, showing nests and sheets of tumor cells (arrow) in the dermis and subcutaneous tissue. The tumor cells are round to irregular with enlarged nuclei, coarse chromatin, minimal cytoplasm and frequent mitoses. (B) Tumor cells from the scalp lesion, showing diffuse and strong membranous immunoreactivity for BerEp4
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F1
Histopathology was consistent with carcinoma that extended into the perineural and lymphovascular spaces, and showed immunoreactivity to cytokeratin CK5, CK6, CK7, and anti-epithelial cell adhesion molecule BerEp4 (Fig. 1A, 1B).
(A) Endoscopic image of a centrally umbilicated nodule in the gastric body. (B) Endoscopic image of two centrally umbilicated nodules of varying diameter in the gastric body. (C) Endoscopic image of an ulcerated, nodular lesion in the duodenum
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F2
Upper endoscopy was performed and revealed multiple raised umbilicated nodules with central ulceration, ranging from 0.7-3 cm, throughout the gastric body (Fig. 2A, 2B) and the second portion of the duodenum (Fig. 2C).
(A) Hematoxylin & eosin stain, showing gastric oxyntic mucosa undermined by nests and sheets of polygonal tumor cells (arrow) with enlarged hyperchromatic nuclei, coarse chromatin, and minimal cytoplasm, similar to that in the scalp lesion. (B) Tumor cells in the gastric lesion show diffuse and strong membranous immunoreactivity for BerEp4 (arrow), while the background oxyntic mucosa is immunonegative
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F3
A biopsy specimen yielded a cellular morphology and immunophenotype identical to the prior scalp biopsy (Fig. 3A, 3B).